If your baby was born in the UK you would have been given a baby red book (parents held health record) after your baby’s birth. The vaccinations schedule is available for you to look at in the immunisations section of the red book. There are occasions when new vaccines are made available, and these may not be listed in the red book at the time you were given it. Please check with your doctor regarding what the up to date recommendations are.

The UK childhood vaccination schedule starts at 8 weeks of age and the following is a copy of this schedule for you to look at:

Please follow this link for the UK childhood vaccination schedule:

http://www.nhs.uk/Conditions/vaccinations/Pages/childhood-vaccination-schedule.aspx

If your child is following the USA vaccinations programme the following link will take you to the most up to date USA vaccination schedule:

http://www.cdc.gov/vaccines/schedules/easy-to-read/child.html

If your child is following any other vaccinations schedule and you would like us to administer vaccines according to that schedule, please bring the vaccinations card to your child’s appointment.

It is important to recognise when your baby is unwell, and what the signs are which should lead you to consult your child’s doctor. When a child is unwell, you may notice that their feeding is reduced or more difficult. They may develop a fever or feel cold to touch. You may see a change in their colour to pale or blue, and they may develop a rash. They may be irritable and crying too much or may become quiet and listless. All these are important signs which should not be ignored and you need to consult with your doctor or the accident and emergencies department as soon as possible

Isotonic Normal Saline drops (Salt/Sea water) can be purchased over the counter from your chemist to use as nose drops if your baby is snuffly. This can be used before feeding to relieve your baby’s congested nose. It is not appropriate to use any other types of nose drops for your newborn baby at this stage.

On the whole a newborn baby does not require any medication unless advised by your doctor. It may be necessary sometimes to give Paracetamol or antibiotics and your doctor will advise on the most suitable medication to give and at what dose depending on your baby’s age and weight.

The best milk for the baby is Breast Milk. It is very important to give breast feeding a good attempt as it is the most appropriate milk for your baby, filled with all the necessary nutrients, and comes readily warmed up and sterile for the baby to have any time. It is well known that Breast feeding enhances bonding with your baby, and protects him/her from infections and later allergies. Formula milk can be used while trying to establish breast feeding, or as an addition to your milk, or if you were unable to breast feed for any reason. Please check with your doctor for advice on feeding your baby.

During a healthy newborn visit, the pregnancy and birth history is reviewed as well as the feeding history. The baby will be examined fully including measuring the weight, length and head circumference, and all body systems such as the chest, heart, pulse, abdomen, umbilicus, hips, eyes, ears, mouth, and genitalia are checked for any congenital abnormalities, or problems such as jaundice or infection.

A chest infection is a broad term used by doctors to describe various chest conditions, the majority of which are caused by a virus. The symptoms are of a fever, cough, chest pain, and crackles heard when your child is breathing. They may also complain of difficulty in breathing. This infection may also be caused by a bacteria and if so will need antibiotics to treat it. Your doctor will know if your child has this type of infection by listening to their chest and advising on what the best treatment is. If you think your child might have a chest infection, it is important that you check this out with your doctor.

You may notice that your child is in pain and pulling on their ear, or you may notice that there is a discharge from their ear. As you will not be able to tell yourself if your child needs any specific treatment for this, it is best to check with your doctor. The doctor will be able to have a look inside your child’s ear and decide if they need any treatment such as antibiotics or ear drops.

Most viruses that cause cold/flu-like symptoms can cause a sore throat and a cough. There is another condition called glandular fever, which is also caused by a virus, which and can give your child a sore throat and enlarged glands in the neck. Your doctor can decide if this is the case or if your child needs any tests to confirm this diagnosis.

Your child is most likely suffering from a viral throat infection, and you can simply treat them with paracetamol for pain relief and with lots of liquids to drink.

Antibiotics can be prescribed for a throat infection if your doctor finds evidence of a bacterial infection such as severely infected throat with pus on the tonsils (tonsillitis), or they find evidence of bacteria on a throat swab (a test to check if there are bacteria on the throat by taking a swab from the throat). Your doctor will be the best person to advise you on this.

Asthma is a condition of the large airways in the lungs (wind pipes) which is characterised by narrowing of these airways, with extra production of secretions (sputum). The most common symptoms are: cough, wheezing, difficulty in breathing, tightness of the chest, shortness of breath. Some children have symptoms only once in a while which can be severe at times, and others may have frequent mild symptoms such as cough at night and cough on exercise only. Asthma can run in the family and you may find that other family members have one or more of the other  ‘atopy’ conditions that asthma belongs to, such as eczema and hay fever.

It is very important that you follow your doctor’s or asthma nurse’s advice, as good asthma control is essential. You child may have been prescribed some inhalers which come in various colours and have different roles to play in your child’s treatment. Please ask your doctor for clarification on how to use each one of them and for how long. It is important that you have your child reviewed by your doctor regularly to ensure that the treatment is working well.

Most babies vomit sometimes without any underlying problems to worry about. However, it is important that you recognise some of the warning signs of other conditions which need medical attention when your baby is vomiting, and those are: excessive vomiting, projectile forceful vomiting, unusual colour to the vomit (greenish, brown, blood), distended abdomen, no stools or wind passed, abdominal pain, your child looks unwell/ill. If any of these symptoms occur or you are worries about your child’s vomiting, it is important that you seek immediate medical help.

Vomiting in a young baby can be seen in a condition called Gastro-oesophageal reflux (stomach reflux), which means that milk flows back up from your child’s stomach to their mouth after feeding (sometimes immediately after feeding and other times much later). It is important that you spend enough time trying to bring up your baby’s wind during and after feeding before you put them back to bed, as swallowed wind can make relfux worse.

If you are concerned about your baby’s vomiting, you should consult with your doctor or nurse to find out if anything else needs to be done for them.

Diarrhoea in children is common, and on the whole is as a result of a viral infection. The most common virus is called Rota virus which is highly contagious, and occurs in particular times of the year. You may have already heard that your child had been in contact with another child who has diarrhoea which is very likely to be of the same cause. Occasionally, diarrhoea is caused by a bacterial infection, especially if you have recently returned from travel abroad.

On the whole, treatment is supportive with plenty of fluids to be given so that your child does not get dehydrated. The best fluids are the oral rehydration solutions called Diarolyte, which you can get from your chemist or your doctor. Do not worry too much if your child does not feel like eating, as long as you are able to get them to drink. It is important to check with your doctor if the diarrhoea is severe or lasts more than 3 days, or if your child appears lethargic with a dry mouth and less urine produced. It is also very important to consult your doctor if you see blood or mucous in your child’s stool.

Longstanding diarrhoea needs to be checked out by your doctor as it is important to find out why this is the case and if your child is affected by it in any way. Some of the causes for longer duration diarrhoeas are: Lactose intolerance (cow’s milk sugar intolerance), Cow’s milk protein allergy, wheat intolerance or allergy, Coeliac disease (Gluten intolerance leading to malabsorption), Cystic fibrosis, inflammatory bowel disease (such as Crohn�s disease or ulcerative colitis), irritable bowel syndrome etc

Constipation is the term used to describe when your child is having difficulties with opening their bowels. This can be when the stool (poo) is too hard, or when they are unable to empty their bowels regularly (less than every 2-3), or both.

it is important that you ensure your child is receiving the correct amount of fresh fruit and vegetables every day and that they are drinking plenty of fluids such as water and juice. Toileting is also very important so that your child is training their bowels to empty regularly.

Please ask your doctor for advice on this and if your child needs medication to treat their constipation.

The most common causes for constipation are: too little natural fibre in the diet (fruit and vegetables), and not enough fluid intake. Sometimes constipation can follow a diarrhoea’ illness or during travelling and being away from home. Excessive milk intake in an older child may also contribute to constipation.

Rarely, constipation can be a sign of other problems such as bowel obstruction, food allergies, coeliac disease etc.

Signs to look out for when your child has constipation, that should raise concerns:

• A newborn or young baby with constipation
• Distended abdomen
• Vomiting, especially if the vomit has a greenish colour
• Your child appears unwell

It is best to consult with your doctor on which are the most suitable medications for your child’s constipation. The usual medications your doctor may advise on consist of a stool softening medication such as Lactulose (a sweet liquid which draws fluids into the stool to make it softer) or Movicol paediatric sachets (a powder that you need to dilute in water and give to your child as a drink), and sometimes a stimulating medication such as Senna (which makes your child’s intestines contract more to push the stool out faster) or other similar medication. It is important that you follow your doctor’s advice when using such medication and not to use them in excess or too long without regular follow up. Your doctor may chose to prescribe other medication depending on your child’s constipation history and how they have responded to the other measures. Please note that any medication relies on good fluid intake and fibre intake and toileting for it to work.

Abdominal pain is one the most common complaints of childhood and may be a symptom of many common conditions such as gastroenteritis (tummy bug), tonsillitis (sore throat), Urinary tract infection (urine/ water infection), and constipation. Less commonly it is a symptom of a more serious condition such appendicitis or inflammatory bowel diseases.

It is important to note any other accompanying symptoms such as: fever, diarrhoea, vomiting, skin rash, mouth ulcers, wetting, soiling, joint pain and swelling, symptoms of generally being unwell. In general, you should be able to give your child a simple pain killer such as Paracetamol, within the manufacturer’s or your doctor’s or pharmacist’s instructions, but you should take your child to see the doctor if they are ill/ unwell, have a fever, they are vomiting or have the other unusual symptoms.

It is likely that your child has a fever, although they may just feel hot to touch if the weather is too warm. It is important that you measure and record your child’s temperature as your doctor will need to know how high it has been to decide how to treat your child. If your child’s temperature is higher than 37.5 C. It is important that you strip your child down to try and cool them down. You may also use tepid sponging if the fever persists or is higher than 38.5 C. To bring the temperature down, you can give a simple medication such as Paracetamol or Ibuprofen according to the manufacturer’s or your doctor’s or nurse’s advice. If the fever is higher than 38.5 C or lasts more than 2-3 days, it would be important you check with your doctor in case your child needs other treatments.

The normal child’s body temperature ranges between 36.5 C and 37.5 C.

The following are important warning signs which you need to keep an eye on and respond to by taking your child to be seen by the doctor or by the Accident & Emergencies department:

• a fever in your young baby less than 3 months of age
• change in your child’s skin colour to pale or mottled or blue
• you are unable to rouse your child or keep them awake
• irritability
• your child making grunting noises or breathing fast or with difficulty,
• your child has an unusual skin rash which does not blanch or fade when you press on it,
• your child has stiffness in the neck or bulging in the fontanelle (soft spot on your baby’s head),
• your child has any abnormal movements or seizures.

Urine infections are fairly common in children. About 8% of children may have a urine infection and generally girls are more frequently affected than boys. It is an infection that can affect any part of your child’s urinary tract (waterworks). Its symptoms depend on which part of the urinary tract is affected but the most common are: burning sensation when passing urine (dysuria), blood in the urine (Haematuria), smelly or cloudy urine, abdominal pain, back or loin pain, fever, wetting. Some young children can get very unwell with a urine infection and may develop a febrile convulsion with it.

The types of a urine infection depend on which part of the urinary tract they occur. A cystitis is an infection of the bladder, a pyelonephritis is an infection of the kidney, a balanitis is an infection of the foreskin, and a vulvovaginitis is an infection of the female genital area.

You will be asked by your doctor or nurse to collect a urine sample from your child. This needs to be done in a very clean way and the urine collected in a special sterile urine pot. Once the urine is collected in such a way, this will be tested straight away by a urine dipstick test and will also be sent to the lab for further analysis to confirm the diagnosis. Your doctor will be able to tell you if the initial test suggest an infection and advise you on what to do. The lab analysis usually takes up to 2 days for the results to come back.

The usual treatment method is with the appropriate antibiotics which your doctor will advise you on. In addition it is very important that you make sure your child is drinking plenty of fluids, and passing urine regularly to clear the infection. If your child has constipation it is also very important to treat this as well.

Most urine infections in children are not associated with any abnormalities of the urinary tract. They can be triggered by your child not emptying their bladder frequently enough, or if they have constipation.

Infrequently some children with a urine infection can have an underlying problem in their urinary tract which can be identified using the special tests that your doctor may arrange, especially if your child was unwell with their infection or if they have had repeated and recurrent infections:

You will be informed by your doctor if any of these diagnoses apply to your child and if any further treatments are needed.

The most common test to request would be an ultrasound scan (gelly on the belly scan), which is a simple and non-invasive test that can show if your child has any anatomical problems with the kidneys or bladder associated with the infection. Your doctor can then decide if further tests are needed to investigate the urine infection further.

You need to discuss this problem with your doctor. Most commonly bedwetting (nocturnal enuresis) is a simple and self-limiting condition which can respond to simple measures such as:

• Improving fluid intake during the early part of the day and at school while reducing the fluid intake in the afternoon and evening.
• Avoiding diuretic drinks such as coffee, tea, blackcurrent juice and fizzy drinks.
• Regular daytime toileting and bladder emptying
• Treatment of constipation
• Remove your child’s nappy or pull-ups to encourage awareness.

Children can have daytime wetting (incontinence) due to a variety of conditions such as:

• Overactive Bladder: an overactive bladder where the child feels the need to use the toilet very frequently (more than 6 times a day) and urgently and may have daytime wetting (urge incontinence) with or without night-time wetting (nocturnal enuresis).

• Infrequent voiding: where the child empties their bladder infrequently (less than 4 times a day), and they may not empty their bladder fully each time.

• Voiding dysfunction: where the child has wetting with withholding behavior and they may not empty their bladder sufficiently. They could also have bowel problems such as constipation

• Giggle incontinence: where your child only wets when they are giggling.

The management of your child’s wetting (incontinence) should always consist of the following simple measures:

• Improving fluid intake during the early part of the day and at school while reducing the fluid intake in the afternoon and evening.
• Avoiding diuretic drinks such as coffee, tea, blackcurrent juice and avoiding fizzy drinks.
• Regular daytime toileting and bladder emptying (bladder re-training).
• Treatment of constipation.

You can use positive feedback to achieve this (positive praise, star charts, reminders).

Please see the following links for examples of a star chart and a toilet training certificate, which you may use or design your own

Link to toilet training certificate: Toilet Training Certif0001.pdf

Link to Star Chart: Star chart0002.pdf

it is important to seek medical help if your child is wetting with any of the following features:

• Your child started to wet again after having been dry for a while (secondary incontinence)
• If your child has had a urine infection
• If your child has blood in the urine
• If your child has daytime wetting (incontinence) as well
• If your child has to use the toilet very urgently (urgency, urge incontinence) and many times a day (frequency)
• If your child has soiling (stool in the pants)
• If your child has excessive drinking and is passing a lot of urine by day and night

• your doctor will ask you many questions about your child’s wetting and urine habits as well as their general health, growth and development. It is also important to let your doctor know if there is any family history of kidney conditions or other illnesses such as high blood pressure (hypertension) or diabetes.
• Sometimes, you may not remember accurately how often your child empties their bladder and how severe the wetting is, or if they are passing small or large amounts of urine, so your doctor will ask you to keep a diary of your child’s urine habits and fluid intake ( how much they drink each time, how often they empty their bladder and how much urine they pass each time, and if they are wet before or after passing urine).
• Please follow this link to obtain such a diary to use before your see your doctor, as completing this will help with your child’s initial and follow-up consultations. Link to bladder diary: Bladder Diary0018.pdf

Your doctor will decide if your child’s wetting could benefit from any further medications or treatments. The types of treatments that are available for the various wetting problems are:

• Desmopressin (Desmotabs’ or Desmomelts’), which is used to treat night-time wetting (nocturnal enuresis) where your child’s urine production at night is large. Your doctor will advise you if this is suitable for your child and at what dose to give it.
• Anticholinergic medications:  These are medications that are used to treat detrusor overactivity (daytime wetting). Your doctor will advise you which is the most suitable for your child and at what dose to use it.
• Enuresis Alarm: Your child may also benefit from using a special alarm at night to treat their night-time wetting (nocturnal enuresis), and this is called the enuresis alarm. You can find out more about this alarm and how to get one from the ERIC website (address available in the links page of this website).