Unfortunately, children don’t come with a guidebook – as much as some parents might want one sometimes – and the list of health and wellbeing woes that can affect children only continues to grow. What advice can you offer to address some of today’s common childhood concerns?

Parents are bombarded on a daily basis with advice, information and even scare stories on issues affecting their children’s health, from self-harm, stress and depression to obesity, allergies and childhood infections. It’s no wonder then that they are often in need of reassurance and advice from the pharmacy team.

Under pressure

A poll commissioned by mental health charity Young Minds revealed that today’s children are growing up in a toxic climate that is having huge implications for their mental health. Over half of children and young people believe they’ll be a failure if they don’t get good grades and half said they’d been bullied, while four in 10 children aged 11-14 skip meals to stay thin. And a third of children and young people don’t know where to get help if they feel depressed or anxious.

To help, the charity has launched the ‘Young Minds Vs’ campaign to raise awareness of the need for improved mental health among young people. “Young people tell us they experience a continuous onslaught of stress at school, bullying, sexual pressures and bleak employment prospects,” says Lucie Russell, director of campaigns at Young Minds. “When this becomes too much for them, they don’t know where to turn for help and when they do, often the support just isn’t there for them.”

As many as 13 per cent of boys and 10 per cent of girls suffer from some form of mental health problem, says the Association of Young People’s Health (AYPH). “We’ve seen an increase in symptoms such as anxiety, depression, stress and eating disorders since the 1960s. Part of the reason could be the big social changes taking place for young people – youth unemployment and having to stay in education until 18 are important factors for some,” says Ann Hagell, research lead at AYPH.

Eight to 14 per cent of teens self-harm, which can be a sign of mental health problems. “For most, it’s a coping mechanism and quite different from suicide,” says Ann. “Given the right support and treatment – CBT works well – most will make a good recovery. But for others, it’s a sign of an underlying problem, such as depression or anxiety, and it should always be taken seriously.”

Cases of depression and anxiety have risen in children and young people over the last 20 years, with around three in 10 now affected. Teens are especially vulnerable to depression, thanks to the biological and social changes going on in their lives. It can be hard to tell if a teen is depressed as it’s normal for many teens to retreat from adults. Signs to watch out for include:

• Persistent sadness
• Lack of interest in life
• Tiredness/low energy that persists for weeks or more
• Moodiness and irritability
• Giving up their interests and hobbies
• Declining school work and difficulty concentrating
• Lack of care for appearance
• Losing contact with friends.

Children can be referred to their local Child and Adolescent Mental Health Services (CAMHS) team through their GP for assessment and treatment.

“Health professionals can help by raising the profile and recognising the signs of depression and anxiety in young people,” says Ann. “Start lowlevel, non-threatening conversations, such as ‘how are you sleeping?’ which can then lead on to other questions. Know where to refer young people for help and link with mental health charities.”

Eating disorders are another way that stress and anxiety can affect young people, with one in 250 girls and one in 2,000 boys affected by anorexia nervosa and around five times this number affected by bulimia. Eating disorders are coping behaviours, which give the person an outlet for their feelings of being out of control. Signs to watch out for include:

• Excessive concern about calories or fear of weight gain
• Abnormal eating habits
• Guilt and shame around eating
• Worrying about being overweight, without reason
• Exercising obsessively
• Feeling depressed and irritable
• Not eating in front of others.

GPs can refer young people for specialist help.

Weighty issues

Some 31 per cent of boys and 28 per cent of girls aged between two and 15 are overweight or obese. And by the age of 11 years, 33.3 per cent of children are overweight or obese, according to statistics from the Health & Social Care Information Centre.

While poor diet is a factor, the increasingly sedentary lifestyle of many children is equally important. The Department of Health recommends that children take at least 60 minutes of moderate intensity exercise a day, yet last year’s Millennium Cohort Study by academics at UCL found that only about half of seven year olds meet these recommendations.

“If we can’t persuade children to take more regular exercise, it will come to a point where they become so overweight it triggers a host of serious health problems that used to only affect much older people – CHD, stroke, type 2 diabetes, liver and kidney problems,” says Tam Fry from the National Obesity Forum.

By the time children reach their teens, activity levels drop off, with only 28 per cent of boys and 15 per cent of girls aged 11-15 doing enough exercise for good health. We also need to do more to persuade teens to eat fruit and vegetables, with girls aged 11-18 consuming an average 2.8 portions a day and boys three portions a day.

“Better training of health professionals in nutrition is essential if we want to improve children’s diets, in particular GPs and health visitors,” says Tam. “But also parents need to think about the food they buy and what they eat themselves.”

By the age of 11 years, 33.3 per cent of children are overweight or obese

Pharmacy staff can help by providing up-to-date information on diet and physical activity, and signposting parents of children with weight concerns to the right services. “We need to monitor children from their earliest years to check they aren’t becoming overweight. Advice in the form of leaflets and posters is useful for parents, but for children it works best given one-to-one or in a classroom setting,” says Tam.

For parents who want to tear children away from TV and computer screens, the best advice is to become a role model and exercise with your children.

 

 

Allergy epidemic

Each year the number of allergy sufferers increases by about five per cent, with half of all those affected being children. And around 50 per cent of under 18s have one or more allergies, says Allergy UK.

Asthma is one of the commonest allergies affecting children, with one in 11 affected in the UK, says Asthma UK. Diagnosing asthma in young children isn’t easy as one in seven has wheezing at some point before the age of five. The signs parents should look for include:

• Breathlessness
• Wheezing
• Coughing, especially at night
• Tight feeling in the chest.
• Better asthma control can help to avoid hospital admission, says Asthma UK, and pharmacy staff can help by asking parents these questions:
• Is the child coughing/wheezing first thing in the morning?
• Is there increased coughing/ wheezing after exercise?
• Are they waking at night coughing/wheezing?
• Is a reliever inhaler not providing relief after three or four hours?
• Do they need more reliever medication but it is having less of an effect?

Adolescents are at increased risk of asthma death, yet are often forgotten when it comes to asthma care, says Asthma UK, either being left in paediatric services or pushed into adult services with little support. With help from Asthma UK, doctors at the University of Southampton are trying to change this. “We found that healthcare professionals don’t effectively communicate with adolescent patients. For example, they use medical jargon, allow parents to dominate consultations and don’t provide opportunity for confidentiality. This lack of engagement perhaps explains their poor asthma self management skills and ongoing asthma symptoms,” says Professor Graham Roberts, consultant paediatrician at the University of Southampton.

The researchers hope to develop a new adolescent approach for healthcare professionals to use.

Headlice

Most common among four to 11 year olds, headlice affect three million children a year in the UK. They are spread by head-to-head contact and will infest clean or dirty hair. Headlice are difficult to spot, as they move fast and blend with the child’s hair colour. Detection combing is the most reliable way to check.

Wet detection combing:

• Wash hair with shampoo and apply lots of conditioner, then detangle hair
• Use a louse detection comb and draw through hair from roots to tips, checking for lice after each stroke
• Rinse and repeat combing procedure in wet hair.

Dry detection combing:

• Untangle hair with a comb
• Use a louse detection comb and draw from scalp to ends, combing each section several times
• Look out for lice as you comb.

Medicated treatments should only be used if live lice are found, and should be used on everyone in the family who is affected. The treatment should be repeated after seven days. Treatments include traditional insecticide formulas and the newer silicone and oil-based preparations that have a physical rather than chemical action on lice. These are thought to be less likely to cause resistance problems.

Wet combing (similar process to wet detection combing) can be used instead of or as well as medicated treatments:

• Wash hair with ordinary shampoo and apply lots of conditioner. Use a wide-toothed comb to detangle hair
• Divide hair into small sections
• Use a louse detection comb and draw through from scalp to ends. Check for lice after each stroke and remove by wiping or rinsing comb
• Rinse out the conditioner and repeat combing on wet hair
• Repeat on days five, nine and 13 to clear any lice as they hatch.

Sickness and diarrhoea

Gastroenteritis is the most common cause of sickness and diarrhoea in young children. It normally lasts for three to five days and most often occurs during winter and spring. It can be caused by the norovirus infection and food poisoning, but rotavirus is the most common cause in young children. It spreads quickly when an infected child doesn’t wash their hands after using the toilet, and it can be carried in the air.

Gastroenteritis can usually be treated without a visit to the GP. However, you should refer children who have:

• Recently been abroad
• Symptoms that don’t improve after seven days
• Persistent vomiting, with no diarrhoea
• Blood or mucus in their stools
• A weakened immune system because of a health condition.

Children who are at risk of dehydration, or who have become dehydrated, should be given an oral rehydration solution and the parent should contact a GP. Those at risk of dehydration are children who:

• Are under one year of age
• Have passed more than five stools in 24 hours
• Have vomited more than twice in 24 hours
• Can’t hold down fluids
• Are not feeding well
• Are under two and had a low birth weight.

Oral rehydration solutions should be given slowly to avoid vomiting.