A snotty nose

My gorgeous niece has recently started at a child minders as her mother has gone back to work. Instantly my sister has discovered....a snotty nose....

I have 4 children. The oldest are 2 and 4. They both continually have a snotty nose. We live in Spain and they even have  a snotty nose throughout the summer. My 2 year olds first Catalan word was ‘mocos’ (snot) ‘mocos nose’ he says half in English, half in Catalan. So, is there something wrong with my children? Should I be worried about the constant stream of gack that they are forever sniffing back up their noses? 

There are several contributing factors to my children’s snotty noses. The first being that they aren’t that great at blowing their noses (they are getting better but they are quicker at sniffing than I am with the hankie.) Hence, the snot hangs around (going backwards and forwards like a slimy yo-yo) rather than being neatly cleaned away and deposited of.

The reason that most children have a snotty nose in the first place is that they are fighting off infections. The nose makes clear mucus that helps to wash away the germs and protects the lungs from invading bugs. When the immune system starts making cells such as white blood cells to fight the infection, the snot will turn white or yellow. Snot is green either because it has bacteria in it, or because certain enzymes which help fight off bugs contain a green pigment.

So why do children have so many snotty noses? Children have immature immune systems. When the come across a bug, they often won’t have met it before and have to learn how to fight it off. Generally, the more bugs they learn about, the better their immune system is. A mature immune system (i.e. an adult one) has learnt about lots of bugs. It has met them before and knows how to fight them off. So when an adult comes across a bug they may not even know that their immune system is busy defending them from attack. Children come across lots of new bugs and it seems as if they constantly have a runny nose or are unwell in some way. Actually, it’s probably lots of different bugs and different infections but they run into each other, seeming like one long snotty nose.

So, no, I’m not worried about my children’s runny nose (other than it is a bit embarrassing when Spanish people tell them to blow their nose in English). That’s not to say there aren’t other reasons why some children have snotty noses, it’s just I know my children have the ‘common garden variety of snotty nose’ and one day they’ll grow out of it (whether that is before or after they become adept at blowing remains to be seen.)

See also:

Babies and Colds (a quick guide)

Breathing problems in babies

Why kids always have colds and snotty noses

Progressing with weaning

So, you've started weaning, you've got through the more food coming out than going in phase, you're used to the fact that your walls are now speckled with orange and you're keen to try new things...


Increase variety and type of food
The rate at which your baby will progress with weaning will depend on your baby and how old they were when you started. You can introduce them to more tastes as you feel they are ready. It’s quite easy to give them what you are cooking for your family and just adapt it for them. For example, last night, we had pasta and I gave my 8 month old baby pasta and peas whizzed up with some cream cheese. You can pretty much whizz up anything, just add some boiled water to thin it if it’s not the texture you want. If I make stew, I’ll take some out before I add the stock, which may seem a bit backwards, but you can adapt your cooking. In fact, your taste buds adapt to the amount of salt they are used to so if you reduce the amount of salt that you cook with, you will find that you don’t need as much salt.


Gradually you can increase the types of food that you give your baby. Introduce protein in the form of meat, fish, pulses and eggs. From about 9 months, babies should be having 3 meals a day with snacks. Introduce lumpy food as well. Lumpy foods should be introduced by about 10 months, but it’s fine to do it earlier if you think your baby will cope with it. You can gradually increase the lumpiness of the food. So, for example, begin by not whizzing the purée so smooth. Then you could add little bits (e.g. small bits of pasta) to smooth food or use a fork to mash things rather than a blender. It is really important to introduce lumpy foods so that you don’t miss the window. If you leave it too late, your child could develop an aversion to lumpy food and will end up on a diet of smooth soup and yoghurt.


If your child doesn’t seem to like a particular food, that’s fine, don’t make a fuss about it. Just keep presenting it to them but don’t avoid it altogether. Before the age of 2, children have an amazing capacity to try new things (after that ‘don’t like it, don’t like it’ will echo around the house). It has been shown that forcing a child to eat a particular food will decrease the liking for that food and that restricting access to particular foods increases rather than decreases preferences. By contrast, repeated exposure to initially disliked foods may break down resistance.

Similarly, it is important not to make a fuss about eating at meals times. Many children go through a phase when they don’t want to eat anything. In our developed world, they are not likely to starve. Have a think about what they eat during the day. Are they having lots of milk that will mean they are not hungry? Or are they filling up on biscuits and other snack food? If you make a fuss about mealtimes, they will manipulate the situation so that meals become a battle (which they will win). I don’t mean that they consciously set out to do so, they just see that a certain behaviour results in a certain behaviour from you.

Remember that the types of foods your baby gets used to will be the types of food that they will like when they're older. So, it's really important that you get them used to eating healthy foods now. Encourage fruit, vegetable, fish, meat and starchy foods. Avoid biscuits, chocolate and sugary treats.

Water

When you start weaning, it’s a good idea to start introducing water. To being with, use cooled boiled water and give it in a sippy cup (one with a spout on the end). Your baby will find it fun to be given a cup and will probably hold it upside down and try to suck a handle but that’s fine. It’s just getting them used to it. They will continue to get their fluids from milk. By the age of one, children should be using cups rather than bottles. Bottles are really bad for your teeth, especially if they have anything other than water in them (milk is also quite sugary and fruit juice, even sugar free juice is acidic.)

Finger food

Babies love putting everything in their mouths. They explore the world by seeing what it tastes like and what texture it is. ‘Hmmm, tastes like yellow duplo’, ‘I prefer blue’! So what a perfect opportunity to help them explore by giving them something edible to explore. Anything they can hold in their hand and are not going to choke on is suitable. Start with a crust of toast, or some fruit. Soft pear is perfect as some fruits can be quite hard. Banana is good if they can grip it but it becomes really slippery (and turn black in the washing machine). Make sure you peel things as they can choke on the skin. You can give them boiled vegetables such as carrot or a lump of potato, hard boiled egg.

Things like rusks and baby biscuits often have sugar added. I often get adult rice cakes that have no salt added, just break them in half.

Family meal times

It’s a really good idea to feed your baby with the rest of the family as often as possible. Not only does this teach them etiquette and how to behave at the dinner table, it encourages them to eat as they see other people eating around them. It is also a lovely sociable experience to spend some ‘family time’ together. I realise that it is difficult for many people whose partners get home late. In that case, sit and eat something with your children at their dinner time and use the weekends to have proper family meals together. Now, I know that I said it would be a lovely family experience, perhaps I should say, that the aim is to have a lovely family experience. It really is much easier to let your toddler sit in front of the television and shovel food down into their mouths as if they were a zombie. But what does that teach them? They need to practice manners and using a knife, fork and spoon and they need to practice without the distraction of the television. There will be days when dinner will be a bit of a disaster, but it is worth persevering. Consult a behaviour book such as Supper Nanny for advice. Anyhow, getting back to the point…If you start your baby having family meals early, it will just be part of the course for them, what they have always known.

This is a good NHS leaflet on healthy eating and children's portion sizes.

Weaning part 4, what to give them.

There are many jars of baby food available which are good for convenience. However, they do become expensive and many of them add things like sugar and salt which are not recommended for babies. Personally, I don’t think it’s particularly difficult to make your own baby food. In fact, even if you’re a hopeless cook, you can probably still manage to cook a few carrots and whizz them together. Jamie Oliver would be proud! Equip yourself with a little food blender (about £10-£15) and all will be plain sailing. You don’t need one of those specific baby ones, they’re much more expensive. Just a normal hand-held one will do (it needs to have a little chamber attachment).

The first things to try are simple food such as fruit or vegetable purée. Try apple, pear or banana. With the apple and pear, you need to stew it first. Just peel it, chop it up, add a little water and heat until soft. Then throw it in the whizzer. Sometimes, I have to confess, I don’t even peel them, it’s going to get whizzed up anyhow. Don’t be tempted to add sugar or honey. The banana doesn’t need cooking, but to begin with, I would whizz it up so that there are no lumps. Banana is a great food, but it’s quite slippery and some babies find it difficult to keep in their mouths to begin with (or in their fingers later on.) Also, be warned that it turns black in the washing machine and makes poo look like black worms.

If you want to try vegetables, think about potatoes, sweet potatoes, carrots, turnips, parsnip, swede, pumpkin or squash. You can boil or roast the vegetable then give them a whizz and hey presto! Be a bit careful whizzing potato as you can break down the starch if you whizz too much and it becomes quite thick. You can still give it to your baby though. Sweet potato and cinnamon is favourite of many babies. If you are cooking something like squash or pumpkin, it can be a little watery and runny. You can always add a little baby rice to thicken it.

When you whizz foods, you have to have a certain amount in the whizzer otherwise it doesn’t work. If it looks too thick, add a little boiled water to thin it out. You can freeze the rest in little ice trays. To begin with, a baby will only need one ice cube but as they get older they will progress to 2 or more. You can then mix and match your vegetables and fruit….carrot and parsnip, carrot and squash, potato and carrot, apple and pear…whatever you like.

When you serve the food, it should be luke warm. In reality, it tends to get cold before it’s eaten. It can always be zapped for a few seconds to reheat it, but make sure it’s not too hot otherwise you’ll upset your baby. Babies have very sensitive mouths so test the temperature on your wrist or your lip before you put it in your baby's mouth.

The start of weaning is a very exciting time for both you and your baby. Be warned, it is messy. (I must have had a premonition when I decided to paint my kitchen orange when I was 38 weeks pregnant.) Anyhow, it's a great opportunity for photos, some future xmas pressies for grandparents.

Next time....Progressing with weaning.

Previous weaning blogs:
How to start weaning
Weaning and when to start
The Rules

Weaning: The Rules!

There are certain ‘rules’ about weaning. Some of the rules have good evidence behind them, some don’t. Not everyone agrees on the ‘rules’. It is worth noting that children need a different balance of diet than we do. A healthy adult diet is high in fibre and low in fats. A baby doesn’t need as much fibre (it will stop them from absorbing so many nutrients) and they do need a higher percentage of fat than we do. They need lots of calories to help them grow. Although, having said that, in the developed world we do have an epidemic of obesity, even childhood obesity, so don’t over feed your children as the long-term consequences will be devastating.

Here are some of the areas that you may read conflicting advice on so may be confusing:

Allergy

Below the age of 5 you shouldn’t give whole or chopped nuts. This is as nuts, especially peanuts are a chocking hazard. They are pretty much the exact size of a child’s windpipe and therefore, especially bad for choking on. It’s fine to give puréed nuts, like in smooth peanut butter. Some people say you should avoid giving them if you are allergic to them but The European Society for Paediatrics, Gastroenterology, Hepatology and Nutrition (ESPGHAN) say :

‘Avoidance or delayed introduction of potentially allergenic foods, such as fish and eggs, has not been convincingly shown to reduce allergies, either in infants considered at risk for the development of allergy or in those not considered to be at risk.’

(They do recommend introducing foods one at a time in case they have an allergy so that you can tell what it is.)

This is also true of gluten. The advice used to be not give gluten (found in wheat, barley and rye so that’s bread and pasta) until at least 6 months of age. However, the advice has now changed and it can be given before 6 months. ESPGHAN say :

“It is prudent to avoid both early (before 4 months) and late (after 7 months) introduction of gluten and to introduce gluten gradually while the infant is still breast-fed because this may reduce the risk of coeliac disease, type 1 diabetes mellitus, and wheat allergy.”

This is not what the NHS says, they say you shouldn't give wheat based products to babies under 6 months. Well, who are you to believe? Personally, I gave my children wheat products under the age of 6 months. You are welcome to read both 'sides' of the argument. The ESPGHAN paper is quite long, the NHS weaning leaflet is not, it just makes a statement rather than giving any evidence. Doctors like evidence. Otherwise the NHS leaflet is a good leaflet which I recommend reading.

Generally agreed guidelines

Below one year of age you shouldn’t give children:

• Salt or sugar. This helps set the child’s threshold for sweet and salty tastes later in life; it helps avoid dental caries (decay) and it doesn’t over-load the immature kidneys with lots of salt.
• Low-fat products.
• Cows’ milk as a main drink. It’s fine to have cows’ milk in part of a meal e.g. in mashed potato or as yoghurt.
• Honey. Honey can contain the spores of botulinum (botox) which occurs naturally in the environment and is a muscle relaxant (hence why when you inject it into your forehead you don’t have any wrinkles because you can’t move your muscles.) However, if you ingest it, it can stop your respiratory muscles and you stop breathing. If the honey has been treated using high-pressure and high-temperature treatments, it should inactivate the spores but it might just be easier to avoid honey for a year.
• Shellfish, pate, blue cheese and soft cheeses with rinds like brie (rather than Phillidelphia), soft eggs should only be given from 1 year. This is because this group of foods is good at harbouring bugs that can lead to food poisoning.

From 6 months you can give:

• Well cooked eggs.
• Citrus fruit (it’s very acidic for young babies).

How to start weaning.

Welcome to "weaning part 2". Your baby is over 17 weeks old, able to sit up and putting everything in their mouth. (See previous blog, Weaning and when to start.)

So, now you have decided that it’s time to start on solids, what should you do? To begin with, the aim is to teach your baby how to swallow food rather than to actually feed them. They should carry on having the same amount as milk as before as the amount of calories that they will get from the ‘solid’ food will be minimal. 

Choose a time when you baby hasn’t just had a milk feed but isn’t overly tired. It doesn’t really matter what time of day it is. Start with something simple like baby rice or fruit or vegetable purée. The consistency of the food should be relatively runny but not too runny. Put baby in highchair. I would advise giving them something to play with, like another spoon (my first son just used to snatch the spoon and we’d end up using about 4 spoons each feed.) Bibs are definitely advisable, you can get ones that cover the arms as well, we call them radiation suits. Put a small amount on the end of the spoon and get it into the baby’s mouth. Sounds easy doesn’t it? Your baby will probably turn their head in every way other than where you want it, it’s okay to steady their head so that they don’t get purée in their eye. Try to place the food on the roof of their mouth as it will stand a better chance of staying in their mouth.

It’s amazing, you put some food in and 3 seconds later, twice as much comes out. Until now, they’ve only sucked on either a breast or a bottle so when you put the food in their mouth, they try and suck it, the result being that it is pushed forward and out of their mouth. Don’t worry, they will get there in the end.

In the next blogs, we'll look at 'What to give them' and 'The Rules'.

Weaning and when to start

In honour of the fact that my niece is rapidly approaching weaning age, I thought I'd do a few articles on weaning. Over the next few weeks, I'll cover the topics:

When to start weaning

How to start weaning

What to give them

The Rules

Today, let's look at when to start weaning.

The Department of Health and the World Health Organisation say that breast milk or formula will meet all your baby’s nutritional requirements until they are 6 months old. They both agree that solid foods should not be given before 17 weeks old (4 months).

The Department of Health advises that your baby should be able to sit up, want to chew and is putting things in their mouth and reaches and grabs accurately. 

The European Society for Paediatrics, Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommend weaning between 17 weeks and 26 weeks.

So, although there is a slight discrepancy in advise, general consensus is between 17 weeks and 26 weeks.

It's important to remember that all children are different. With my first child, I thought I would hold off weaning him until he was 6 months. But from an early age, he showed all the signs of wanting to be weaned. He would watch us as we ate and seemed very interested in food. His evening feeds were getting earlier and earlier as he was clearly hungry. I ended up weaning him at 17 weeks and he took to it like a duck to water.

With number 2, I thought I'd do the same thing. I started at 17 weeks and it was as if I was trying to poison him. I delayed a few weeks and everything turned out fine.

Don’t leave weaning too long after 6 months as there is a window of opportunity. Babies who are weaned too late can develop problems swallowing lumps and also, they will need more calories and iron than milk alone can provide. 

Beware sugary drinks!

A study by the University of Glasgow has reported that people hugely underestimate the amount of sugar in drinks that are perceived to be 'healthy' such as juices and smoothies. This included not only fizzy drinks but also regular drinks such as apple juice and orange juice. They suggest that the average person in the UK consumes around 450 calories a day in (non alcoholic) drinks. That's amazing, that's roughly 2 chocolate bars worth of calories. 

I remember buying a bottle of 'water' in a garage once to discover that it was 'flavoured mineral water'. It was  made with mineral water and looked like mineral water but contained flavourings including sugar…so, er colourless squash then? Rather than 'water'.

On a serious note, we do have an epidemic of obesity in the UK, mainly affecting adults, but increasingly being seen in children. (Sadly with complications of obesity now being seen in children, like type 2 diabetes). Generally, the eating habits that you develop in childhood will continue into adulthood. So, if your child drinks water and eats healthily, they are likely to continue to do so as an adult. Equally, if they drink lots of sugary drinks and unhealthy snacks as a child, they will as an adult. I'm not saying that children should never have sugary drinks and treats, but that mostly they should eat healthily and have treats as treats.

Another thing to consider is their teeth. Brushing twice a day is great, but their diet also contributes to dental health. There is an increasing epidemic of dental decay in children (especially in Scotland, where the research was done.) Sugary drinks are among the worst culprits, along with sweets, particularly those that you suck. Once you have your second set of teeth, that's it, there are no more.

So, as Dr Seuss says "Don't gobble junk like Billy Billings. They say his teeth have fifty fillings!"

And don't be a sop, drink water instead of juice or squash or pop….

University of Glasgow

In praise of reward charts

When bringing up children, parents quickly realise that the maxim 'reward good behaviour and ignore bad' only goes so far. Apart from anything children need to be told that bad behaviour IS bad behaviour, it's not as if they're born knowing. So, inspired by supernanny, I have frequently fallen to the reward chart to try and improve my children's behaviour.

A few weeks ago, my 3 year old was quite unwell for a few days with high temperatures. He had to have 3 days off school and lay either asleep or languidly watching the TV. When he was well enough to go back to school he was much improved, but not his normal self. He had tantrums and generally his behaviour wasn't great.

Time to pull out another reward chart. My reward charts are generally quite simple and I let him choose what theme he wants. This time it was 'rockets' so we drew a big moon with 7 rockets surrounding it. Each rocket had to get 6 stars to reach the moon. So 6 stars and then he can have a reward (normally a couple of sweets). I have to say I arrange it so that he can generally get one reward a day. Reward charts don't have to be pictures on paper, we once had a reward 'treasure chest' that we had to put 'treasures' in.

You can use reward charts for specific things such as 'keeping your room tidy', 'brushing your teeth', 'getting dressed by yourself'. But I also find them useful just for 'good behaviour' i.e. no tantrums and no snatching toys from your younger brother. That way, I am constantly reminding him what is considered good behaviour. So, a star for eating your breakfast nicely (and behaving well around that time), a star for eating lunch and dinner nicely, a star for behaving well at bath time and another for going to bed nicely. Plus a bonus star for 'something that I want to reward', generally being nice to his brother. (Not at all contrived!)

Supernanny says that you can also take away stars for bad behaviour. I sometimes threaten it, but rarely do, perhaps my children are a little young for that.

The main problem that I have with star charts is finishing them. After a few days, we all seem to get a bit bored of them and forget to stick the stars down. But that must be a good sign that whatever bad behaviour was the issue is now resolved. I think they're really effective. And if all else fails, as a friend recently joked, you can always roll them up and use them to swat your child...

Check out what super nanny has to say on reward charts.

Why kids always have colds and snotty noses.

My cousin wrote to me recently saying that she was worried that her 17 month old son gets so many coughs and colds. So, I thought I'd write a blog busting some of the myths surrounding children and infection.

The first thing to say is that children get ill...lots. Mostly coughs, colds and snotty noses, with the occasionally vomiting and/or diarrhoea bug thrown in for variety. As upsetting as it is, this is all part of their immune systems maturing and learning to cope on their own. When they are born, they borrow an immune system from their mother. They have lots of antibodies (things that fight infection) swimming round their bodies. Antibodies can recognise specific illnesses if they have been exposed to them before (which is how vaccinations work). Because the mother's immune system is mature, i.e. has seen lots of bugs, the baby has help fighting off illnesses. If they are breast fed, this affect is increased because there are antibodies in breast milk.

As the baby gets older, the maternal antibodies wear off and the baby starts to make them for themselves. However, this doesn't happen overnight so young children are more vulnerable than adults to infections. Each time they get an illness or a bug, their immune system increases its ability to recognise things as bugs. However, there are so many bugs around that just as they are getting over one, another comes along and they have to start over again. (Sometimes it feels as if a child has been ill with the same bug for weeks and weeks, but probably it is several different bugs in a row.)

Children are 'allowed' to have (as a rule of thumb) 10 coughs and colds a year before a doctor would even consider doing tests to see if there were any other problems. (And even then the doctors wouldn't really get excited unless they had 'significant' illnesses, for example, needing to be admitted to hospital.) Given that most of these 10 coughs and colds occur in the winter months, it can feel like your child has a snotty nose all winter.

Children who are exposed to more bugs (go to nursery or have older siblings in nursery or school) will get ill more often. Washing hands is a very good way of preventing illnesses as a lot of bugs are spread by touch. 

The (nearly) last thing to point out is that colds are viral infections. Most infections are caused by bugs that are either viruses or bacteria (fungi can also cause infections.) Antibiotics only work on bacteria, they don't do anything to viruses. (It is possible to get antiviral medicines, but generally they are used for very severe infections.) The vast majority of coughs, colds and tonsillitis are causes by viruses. Antibiotics won't help at all. So mostly children don't need antibiotics when they have coughs, colds and tonsillitis. (If they have 'bactierial tonsilitis' they will benefit from antibiotics.)

Finally, children who have asthma may be more affected by coughs and colds because it can trigger the asthma. If you are worried about your child's breathing when they have a cold, you should go and see your doctor. 

Quite a lot of information in one blog but I hope it has given you some insight into why children always have snotty noses.

Check out snotty-noses.com for more information on breathing problems and fever.

Children carrying heavy back packs causes back pain.

A recent study in Spain showed that children aged 12-17 were carrying backpacks to and from school that were so heavy that they caused the children back pain. Over 60% of the 1403 children studied were carrying bags that were over 10% of their body weight. The authors say that this could lead to back pathology.

This is surely not a new problem. I remember lugging heavy bags to and from school. In fact, some days it was school bag, sports kit, instrument, basket full of cooking stuff and huge folder of arts stuff. Anyhow, that was a very long time ago! It seems like things haven't changed much (and the poor Spanish children have to do the trip twice as many times as those in the UK as they have morning school and then afternoon school.)

Back pain is a huge problem. 80% of people will suffer from back pain at some stage of their life. (Having heavy children who need 'hoking' in and out of car seats and cots and who aren't quite up to walking in the right direction when required is definitely a source of back pain.)

I'm not quite sure what the answer is to this problem, but it does seem to me that we should be addressing it at an early age. Perhaps schools could add 'back education' to the sex education classes. Or perhaps we should exchange all those heavy school books for a sleek, light-weight iPad.

Here's a link to the article, but you'll need an athens password to access it. 

To share or not to share (a bedroom)

When we moved to Spain, nearly a year ago, my husband announced to me that our 2 young sons, then just 1 and 3 were going to share a room. I think my first response was "are you as mad as a goat?" (Spanish saying). We had recently spent a rather sleepless week in Spain, with them sharing a room, albeit a very small room. However, I could see my husband's point of view, the children's bedroom was very large and if they didn't share a room, one would have to take up the spare room and they wouldn't have much space as there is a large unmovable double bed in it.

So, they went into the same room with reasonably good results. Occasionally the oldest wakes up screaming and by the time I've hot-footed it downstairs, he has already woken up the youngest (who is the more 'fragile sleeper'). More often, the youngest wakes up. He is going through one of those 'phases' of waking up, apparently it won't last forever. In the meantime, he can cry for some time. (I keep meaning to dig out my ear plugs). If left in his own room, he will eventually wake up his older brother who surprisingly manages to sleep through quite a lot of crying. Normally, I put him in the travel cot in the spare room. The door in the spare room closes properly which means that his cries are muted somewhat. (I would happily have him in bed with us which is, I think, what he wants, but after about half an hour, he starts playing and singing and more to the point, I know it means he'll wake up again the next night.)

On the whole, I would say putting them in the same room has been a good move. They clearly like being in the same room together. Some times the little one cries because the oldest has already gone to sleep and he doesn't have anyone to amuse him. Last night one of them was blowing raspberries to the huge amusement of the other. They talk to each other and sing before going to sleep. And in the morning occasionally they entertain each other before I've made it downstairs. 

Soon perhaps they'll be making me breakfast in bed!

Children and tummy aches.

Children of all ages often complain about having tummy aches. Frequently it's just one of those things that disappears by itself. (When my 3 year old complains of having a tummy ache, it's normally because he needs to do a poo.) But how do you know if it's something serious?  Or, what most people want to know is, why? What is causing my child's tummy ache?

Well, the interesting thing about medical science is that it may be able to do amazing things like face transplants and brain surgery, but often it can't tell you why your child has a tummy ache. Even if children are admitted to hospital and lots of tests done on them, often we don't find out what the cause is. What you as a parent wants to know is 'what is it' but what your doctor wants to know is 'is it serious'? Two slightly different questions.

So, let's start by thinking about things that might make us think it's serious. Firstly, how is your child? Are they well or unwell? If they're unwell, fever, not eating, vomiting, that sort of thing, your doctor will want to know if they have appendicitis. Appendicitis is an infection of a little bit of your gut that sits in the lower right hand bit of your tummy (in the majority of people). The appendix isn't really thought to be used for much in humans, apparently rabbits have large appendices, something to do with digesting all that grass but don't quote me on that.  Anyhow, the point is it can get inflamed and infected and then it needs to be removed with an operation. Your doctor will do lots of prodding and poking your child's tummy to help them decide if they may have appendicitis.

What else would make your doctor concerned? If the tummy pain had been going on for a long time, if your child wasn't eating or growing well. If it was associated with symptoms such as diarrhoea (over a long period of time, not just for a day or two) or blood in your poo.

There are lots and lots of causes of tummy ache and some are easily diagnosed. For example, constipation, urinary tract infections and diarrhoea are all common causes of tummy ache. Sometimes children get inflamed lymph nodes in their tummy when they have an infection somewhere else ('abdominal lymphadenitis'). But sometimes it has to be put down to 'one of those things' and hope that it doesn't last too long.

Getting children to eat fruit and vegetables.

Most parents wonder how to give their children a healthy diet, how to make them eat fruit and vegetables and how to reduce the amount of cake, crisps and biscuits that they eat. Well, help is at hand. Recent studies by City University and the School Food Trust has found that cooking clubs and classes has a positive effect on children's eating habits. They found that more children ate fruit and vegetables after the classes and were able to recognise healthy food.

Given the growing epidemic of childhood obesity this is fantastic news. Getting children involved in cooking is a 'fablious' idea, as my 3 year old son says. The up sides are huge, learning what goes into food, how long it takes to prepare, giving them skills for later life (not just being able to cook but impressing the fairer sex according to my husband who claims I fell for him thanks to his amazing risotto.) Let's not mention the mess and the amount of extra time needed! When they're old enough, they might even cook the meal by themselves.

From a personal point of view, I find that my children are much more likely to eat something new if they've helped make it. I use the word 'helped' in the loosest sense. My 3 year old 'helped' me to cook mussels the other day. I de-bearded them, passed them to him, he dabbed a few of them with a sponge and put them into a colander. Anyhow, he ate the mussels and was very proud to have helped. A few weeks later I cooked mussels again, this time he was watching tele. He wouldn't touch them. Yuk yuk, I'm not eating those! This 'helping' tactic has also worked with curry and other new and unknown foods. 

In my clinics, I often recommend that children get involved with cooking, especially those who are slightly over weight and constipated (a frequent flyer in many paediatric clinics.) Many parents try to hide vegetables in dishes and this is certainly one way of getting children to eat vegetables in the short term. But I wonder whether it is a good tactic for the long term, when the child is able to decide themselves what they want to eat (which happens very quickly). If they are used to eating fruit and vegetables they will often opt to have a healthy piece of fruit as a snack instead of a piece of cake or a biscuit. (Not all the time I grant you.) I leave bowls of fruit on the kitchen table and both my 1 and 3 year old will help themselves to it. "Norange, norange" grunts my 1 year old.

Feeding children, of what ever age is not easy. Just when you think you've got it nailed, your perfect eater turns into a fussy eater overnight. They don't have to have a perfect diet. Cakes, biscuits and other treats are fine in small quantities. However, it is important that they eat fruit and vegetables, not just today but as they grow and continue into adulthood. If you're having problems getting your child to eat healthily it may feel like a steep slope to climb, but take it one step at a time. Get them involved, don't loose heart and keep presenting them with healthy options.

Molluscum contagiosum or those funny wart things kids often have.

Molluscum contagiosum is a very common childhood viral infection. It is similar to warts, causing  pearly white papules that are shiny and have a little dimple in the middle. It is most common in children between the ages of 2 and 5. The papules may clear up in a few weeks but more commonly they don't go for a couple of years. Eventually they do go by themselves.

Normally no treatment is needed. However, if they cause problems such as rubbing on clothing or becoming painful and inflamed, they can be treated using cryotherapy (liquid nitrogen) or diathermy (often used in surgery to cauterise blood vessels). If the molluscum is really bad, it may be necessary to see a dermatologist.

Children can go to school or nursery if they have molloscum contagious.

Image:  E van Herk

http://nl.wikipedia.org/wiki/Gebruiker:Evanherk

http://creativecommons.org/licenses/by-sa/3.0/deed.en

Urinary Tract Infection in children

Urinary Tract Infections in children are mostly a matter of anatomy. They are normally caused by bugs tracking up the urethra (bit where the wee comes out) and colonising the bladder. Under normal circumstanses the bladder is a sterile environment, meaning that there is no bacteria in it. The bottom end of the urethra however, sits in an area that is not so sterile; quite close to the anus (where the poo comes out.) Needless to say, poo is not sterile. In fact, it has lots of bacteria in it. (But that is normal, it supposed to have some bacteria in it, known as 'commencals' or good bacteria.) If the bacteria stays where it supposed to (i.e. in the poo inside you and not in your bladder) then all is well. Often, however, the bacteria manages to get from the poo, or surrounding area and tracks up the urethra into the bladder, causing an infection, a 'urninary tract infection' or 'UTI', commonly known as a 'wee infection'. Due to anatomy, UTIs are much less common in boys. The bacteria needs to track all the way up the urethra (i.e. the inside of the penis) and into the bladder. This is a much longer length than in girls, in whom the bladder is quite close to the opening of the urethra.

A urinary tract infection can occur higher up in the urinary tract. A kidney infection is a 'higher urinary tract infection', know as 'pyelonephritis'  whereas a bladder infection is a 'lower urinary tract infection' or 'cystitis'.

An anatomical abnormality will also predispose children to having a urinary tract infection, but they are still common in children who have entirely normal anatomy.

Symptoms

Symptoms of a UTI vary with the age of a child. A young child may have a temperature, vomiting, lethargy, irritability and poor feeding. Older children (generally those over 3) may also show signs of being in pain when doing a wee ('dysuria'), they may go to the toilet a lot ('frequency'). (Obviously if they are old enough they can tell you that it hurts.) You may also notice blood in their urine ('haematuria'). Other symptoms include tummy pain, offensive or cloudy urine.

Diagnosis

If your doctor (either your GP or in the hospital) is concerned that your child has a urinary tract infection, they will do a urine sample. This is really easy with older children, you just get them to wee into a sterile pot. With younger children in nappies, it is much more difficult. The best sample to get is called a 'clean catch' and this involves sitting around with your child's nappy off, hoping to catch a drop of urine in a pot when they do a wee. There are other methods, such as a special pad that can be put into their nappy. If your doctor is really worried, they might need to put a needle into the baby's bladder and get some urine. (This is not as bad as it sounds! Sometimes it is easier than getting blood out of a baby.)

Treatment

Urinary tract infections are treated with antibiotics. The antibiotics may be given by mouth or by a drip depending on how severe the illness is. The majority will clear up with antibiotics in a couple of days. Some children will also need follow up imaging such as ultrasounds.

Avoidance

As well as maintaining good personal hygiene (clean genital area) it is important for children (especially girls) to wipe from 'front to back' after going to the toilet. This is so that bacteria from around the anus is not brought forwards towards the urethra. Constipation can also precipitate urinary tract infections (see blog post Kids and Constipation.) Drinking sufficient amounts of water and making sure you go do a wee when you need to (i.e. not holding onto it) can also help prevent urinary tract infections.

Breast fed babies and irritability.

The Medical Research Council (MRC) published an article today in a journal called Plos ONE that said that breast fed babies are more likely to be irritable at the age of 3 months than their bottle fed counter parts. The paper suggests that mothers perceive the irritability as stress when in fact it is a signal of hunger and entirely normal. The authors say that breast feeding is still much better for babies than bottle feeding and that this study is useful as it prepares mothers for the reality of breastfeeding.

One of the researchers, Dr Ong says (to paraphrase) that bottle fed babies may appear more content, but they may also be over-nourished and gain weight too quickly. He points out that as with adults, feeding is comforting. I think this observation is very interesting, especially as breast fed babies are much less likely to suffer with obesity later in life. It is much easier to overfeed bottle fed babies that breast fed babies for several reasons. Firstly, a breast fed baby has to work quite hard to get the milk. It normally takes at least 20 minutes to breast feed a baby whereas a bottle fed baby can devour a bottle in a couple of minutes.

Another reason is that all babies, whether they are formula fed or breast fed will be irritable at some stage. It can be really difficult to know why they are crying or unsettled. It may be because they are tired, hungry, over stimulated, under stimulated, have wind or a bit of discomfort. How are you supposed to know? If they haven't been fed that long ago, parents may give them some more milk. If they are breast fed, they can only get whatever is in breast (i.e. probably not that much if they weren't fed too long ago.) However, with a bottle fed baby, they can be offered a whole new bottle. And no doubt, whatever the original cause for complaint was, they'll be pacified with more food. Lastly, a bottle fed baby's stomach may stretch due to the amount of liquid that they are given at once. This means that they'll want more next time they're fed.

The authors suggest that the extra irritability may be one of the reasons why mothers give up breast feeding. In the UK, we have really low rates of breast feeding compared to other countries. Many women do try to breast fed, but many give up. According to an article in Pediatrics (1), published in 2008, the most common reason cited was that "milk alone didn't satisfy my baby". The authors of the MRC study suggest that in fact, it may not be that the baby isn't satisfied, but that they are naturally slightly more irritable.

They do also point out that other studies have previously had conflicting results (some noted no difference and some noted that that breastfed babies were less irritable.) Both my babies were exclusively breast fed and I found neither particularly irritable. I also found breast feeding really useful when they were unwell as they found it so comforting. (You can continue to breast feed even if your baby has diarrhoea or vomiting.) There is no doubt that breast feeding can be particularly difficult to begin with (both for the mother and the baby) but once established it is normally hugely satisfying for both.

They say that this is part of an ongoing study so hopefully they'll publish another paper telling us what breast fed babies are like when they are a bit older.

(1) Li R, Fein SB, Chen J, Grummer-Strawn LM (2008) Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year. Pediatrics 122: Suppl 2S69–76.

Kids and constipation

I thought I'd write a brief article on children and constipation as it's such a common complaint. I remember when Jamie Oliver did his school dinners programs, he was astounded to find out that a particular hospital in the north had a special clinic for children with constipation. What he didn't mention was that many hospitals in the UK have a special clinic for children with constipation. It is one of the leading complains that children present to paediatricians with.

Symptoms

Typically a child with constipation will have hard, dry stool (poos) and not go to the toilet very often. (It can be difficult to say what is normal in terms of how frequently a child goes to the toilet but I would consider normal to be once or twice a day and constipation to be less than 3 times a week.) When constipation gets bad, there is a back-log (excuse the pun) of hard poo. Behind the hard poo is soft watery poo which can leak down the sides. So strangely, a child with constipation may actually appear to have diarrhoea.

Constipation can also be very painful, so children can present with tummy aches.

Causes

There are many factors that contribute to having constipation: not drinking enough water, not doing enough exercise. Sometimes children get a small cut in their anus (where the poo comes out) which makes it painful to poo, or sometimes they have a bad experience which leads them to 'hang onto their poos' which can lead to constipation. There are also diseases that cause constipation.

However, the most common cause by far is not eating enough fibre (i.e. vegetables). Fibre is the bit of food that our bodies cannot digest. It sits in the bowel, bulking out the poo and making it easier for the poo to pass through the body. When I'm explaining constipation to children, I use an analogy of a tube of toothpaste. When a tube of toothpaste is full, you press it a little and toothpaste comes out easily (a bowel full of fibre). When the tube is empty, you have to squeeze really hard to get just a little bit out. That is a bowel without any fibre.

What can I do to help my child?

The first thing to think about is vegetables. Many people think that their children eat enough vegetables. But chances are, if they are a little over weight or have constipation, that they don't. I ask children what their favourite vegetable is and if they answer 'chips' (which they frequently do) I begin to suspect that they don't enough of the green ones! (That is generally where the fibre is). 

Some vegetables, such as potatoes and cucumber don't have heaps of fibre (it's all in the skin, so if you peel that away, there isn't that much left.) Vegetables that are a bit more woody have more fibre (wood is also fibre but I wouldn't recommend eating it.) Broccoli, sweetcorn, cabbage, beans are all good fibre boosters. 

So how do I get my child to eat more vegetables?? Well, that can be a difficult one. Ideally you start right at the beginning, when you wean them. If they are used to eating vegetables from a young age, they will carry on (ok, they'll probably eat sweets and chocolate too, but at least some of what they eat is the good stuff.)

Leading by example is also a really good way of getting your children to eat vegetables. Young children are desperate to be grown up and considered 'a big boy or girl'. My 3 year old didn't used to eat greens like cabbage or lettuce. I wasn't that worried as he was good with other things like peas and carrots. Then, a few months ago, he started asking for bits of cabbage when I was serving it to the adults. Now he always has a piece of cabbage or beans (still not keen on lettuce).

I also used to grow peas in the garden when he was little (we only had a tiny garden, I didn't manage to grow much else.) I didn't even manage to grow enough to eat them. My little then 1 year old would always be helping himself. But what better introduction to green vegetables that peas picked out of the pod?

If your child is older, how about getting them involved in the cooking. (I know, I know, it's FAR FAR easier just to do it yourself, but it should get them interested in what they're eating and they'll learn how much effort goes into each meal.) Anyhow, make sure you cook something with lots of veggies in…

Other than vegetables, you can encourage your child to go to the toilet. If you put them on the toilet after dinner the chance of them doing a poo is increased (due to a particular reflex that we have.) It's important to sit in the 'poo position' which is back straight (rather than leaning forwards which can make it difficult to poo). If you child is young, they may need a step to rest their feet on. Drinking lots of water and exercise can also help people with constipation.

Summary

Mostly constipation is an avoidable or at least curable illness. It can be very unpleasant and lead to further problems (such as wee infections.) So if you're child has constipation or you think they may have constipation:

Make sure they are active, drinking enough and EATING LOTS OF VEGETABLES.

For more information on what is a portion size for each fruit or vegetable check out this leaflet on the NHS website. Remember the portions published are for adults, they say a child's portion should be roughly what they can hold in their palm.