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Parents across the country may be breathing a sigh of relief as the new school year gets underway, but that can swiftly change to a sigh of despair if their children start coming home feeling unwell.
From cough and cold to chickenpox, conjunctivitis and those dreaded stomach bugs, the result can be discomfort, disturbed sleep and in some cases time off school.
Fortunately, many such conditions are usually short-lived, and pharmacy staff can advise on appropriate products and self care tips to help make young patients more comfortable. Do consider the child’s age and any contraindications and remind parents to read the patient information leaflet carefully – keeping in mind that what’s OK for an older child may not necessarily be suitable for a younger sibling.
Here we take a closer look at some common childhood complaints:
Common conditions
“Some 90 per cent of children will have had chickenpox by the age of 10,” says Helen Bedford, professor of Children’s Health at UCL Great Ormond Street Institute of Child Health. Caused by the varicella-zoster virus, the disease is known for its itchy, spotty rash – which can appear anywhere on the body – and is highly contagious. “It can be transmitted for one to two days before the rash develops, so can be passed on before it is recognised that an individual has chickenpox,” explains Helen. “It remains infectious until all the blisters have crusted over, usually five to six days after the rash appears. It’s important to keep infected children away from pregnant women, immunocompromised individuals and very young babies.”
There’s no specific treatment, continues Helen, but remedies from the pharmacy may help with the symptoms, such as paracetamol to reduce fever (e.g., Calpol), calamine lotion and cooling gels to soothe itching, or chlorphenamine (an antihistamine). Check that any medicines are suitable for the child’s age and medical history. Parents should not give nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to children with chickenpox (unless advised to do so by a doctor), as it has been associated with serious skin infections.
“Remember, as chickenpox is highly infectious it’s better to call ahead to the GP,” says Helen. “Most cases of chickenpox can be managed at home, but medical advice should be sought if the child develops any abnormal symptoms.” These may include:
- The blisters becoming infected, or the surrounding skin getting hot, red and sore
- Signs of dehydration
- Difficulty breathing/chest pain
- Any sudden worsening of symptoms.
If there’s one condition guaranteed to make parents groan, it’s lice. Yes, these tiny insects are largely harmless in the grand scheme of things, but they’re about as welcome as an unwanted house guest at Christmas. Not to mention annoyingly itchy.
Head lice can affect anyone, but they’re especially common among children of primary school age. Parents trying to tackle them might be contemplating a wet combing approach or an insecticide, and pharmacy staff are ideally placed to discuss the pros and cons of each.
One of the advantages of wet combing is that there are no contraindications, says Declan Lismore, superintendent pharmacist at LloydsDirect. Other benefits include the fact that kits can be reused and that resistance to insecticides is not an issue.
Cure rate from wet combing are lower than other methods, however, according to the National Institute for Health and Care Excellence (NICE). Plus the process can prove time-consuming – four combs are recommended over a fortnight – especially if multiple family members need treating, as several sessions are required.
A physical insecticide (e.g., dimeticone) kills head lice by coating them so they can’t breathe, while a traditional insecticide (e.g., malathion) poisons the lice. However, some parents prefer not to use an insecticide on their children and in some cases, head lice can become resistant to malathion.
While for many the choice of treatment may depend on cost and personal preference, NICE says that wet combing or dimeticone 4% lotion is the first-line recommend action for children aged six months to two years, pregnant or breastfeeding women, and those with eczema and/or asthma.
Whatever the method used, parents should check everyone in the household afterwards with a detection comb to make sure no live head lice remain. Patients should see their doctor if the infestation persists after repeated treatment, explains Declan, or if they have an intolerance to OTC treatments.
The common cold is aptly named, especially where young children are concerned. On average, those in nursery or primary school typically have around five to eight colds a year, gradually building up their immunity. Symptoms can include a blocked or runny nose, coughing and sneezing, a sore throat, muscle aches and/or a raised temperature.
Most colds clear up within a week or two, but in the meantime, parents can help by encouraging their child to rest and drink fluids such as water, and offering suitable relief (e.g., a children’s paracetamol). Decongestants should not be given to children under six, and that aspirin should not be given to under 16s (unless prescribed by a doctor), according to NHS advice.
While many youngsters will soon bounce back to full fitness at home, parents may sometimes have to contact a GP – for instance, if the child has a barking cough (which could be croup), a sore throat that persists beyond four days, or signs of a chest infection or whooping cough. In urgent cases (see boxout), they should be taken to A&E.
“Eczema is an incredibly prevalent skin disease in children, with one in five affected by the condition,” says Dr Rishika Sinha, consultant dermatologist and British Skin Foundation spokesperson. “Individuals with moderate to severe eczema report that it disturbs their sleep and affects their day-to-day activities, including the ability to concentrate at school, or take part in sports activities such as swimming.”
Though there’s currently no cure for eczema, there are a range of products available in the pharmacy to help manage it, and many children see their condition improve as they grow up. Emollients and soap substitutes can help to repair the skin barrier and hydrate skin, says Dr Sinha, adding that soaps, shower gels and fragranced creams are best avoided with eczema. In some cases, patients may be prescribed a topical steroid by their doctor.
People should be referred back to their GP if the eczema is widespread, weepy or crusted, if there are small water-filled blisters on the skin or ‘punched out’ lesions, or the eczema is not responding to treatment, she adds.
A stomach bug is bound to make any parent’s heart sink – but the good news is most bouts don’t tend to last long. One of the most common culprits in children is rotavirus, which can cause nausea and sickness, stomach ache, diarrhoea and a mild temperature.
Keeping hydrated is important, so parents should encourage children to regularly drink fluids such as water (or continue with breast or bottle feeds, if applicable), and avoid fruit juices or fizzy drinks. Children should also get plenty of rest and can eat if they feel hungry.
Some patients may benefit from a rehydration treatment (such as Dioralyte), which can help to replace essential body water and salts in the event of acute diarrhoea. Loperamide is also available to buy in the pharmacy to relieve diarrhoea in older children aged 12 and up.
To reduce the risk of spreading the virus, children with a stomach bug should stay home from school for at least 48 hours after the diarrhoea and/or vomiting has stopped (and not use swimming pools for two weeks), follow good hand-washing practices, and avoid sharing towels and utensils. Soiled clothing or bedding should be cleaned separately on a hot wash.
An inflammation of the conjunctiva, the clear membrane that protects the eye, can be caused by an allergy (allergic conjunctivitis) or infection (infective conjunctivitis). Symptoms may include red, itchy and watery eyes, sometimes with a sticky, gunky discharge.
Conjunctivitis can be spread via droplet transmission from coughs and sneezes, says Declan, and is common among young children, who will often rub their eyes without washing their hands. However, allergic conjunctivitis is not contagious.
Symptoms will usually resolve within a week or two. To help ease them in the meantime, parents can gently wipe the child’s eyelids using a clean cotton wool pad dipped in water that’s been boiled and left to cool. They should wipe in one direction (outwards, starting from the corner by the nose) and always use a fresh pad for each wipe/eye. Other tips include encouraging the child to wash their hands regularly and not rub their eyes.
In the event that treatment is required, chloramphenicol eye drops/ointment are available from the pharmacy [for use in patients over the age of two], says Declan, adding that the ointment is preferred for easier application in children. Pharmacy staff should refer if the patient is younger than two, he continues, or if they can’t open the eye due to pain or swelling, are sensitive to light, or the problem persists after using OTC eye drops.
When to seek urgent help
Finding that a child has a fever can be frightening for families but unfortunately it can be common during childhood, as it’s the body’s natural response to an infection. Suitable fever and pain relief (such as children’s paracetamol or ibuprofen) can usually help to lower their temperature.
Among other scenarios, further examples of when a parent or carer should contact a GP or 111 include:
- If a child is under three months with a fever of 38°C or above, is three to six months with a temperature of 39°C or above, or they appear to have a high temperature
- A child showing signs of dehydration (e.g., sunken eyes, no tears when crying, nappies that aren’t very wet)
- A child with a high temperature for five days or more, or showing other signs of illness (e.g., a rash).
Parents or carers should call 999 or visit A&E immediately if a child is showing signs of suspected meningitis, sepsis or other life-threatening illness. Some symptoms that should ring alarm bells include a rash that doesn’t fade when a glass is pressed against it; stiff neck; dislike of bright lights; unusually cold hands and feet; difficulty breathing; a weak, high-pitched cry; a severe allergic reaction; heavy bleeding; a child being drowsy or floppy, or their skin, tongue or lips turning blue, grey or blotchy. This list is by no means exhaustive, and parents should always trust their instincts and seek urgent medical attention if concerned that their child is seriously unwell.
To find out more about meningitis, visit the Meningitis Research Foundation. For more on sepsis and how to spot the signs, visit The UK Sepsis Trust.
Sensitive skin
It’s estimated that up to one in four babies are affected at any given time, suffering from red, itchy or sore skin around the delicate nappy area. In mild cases, a barrier cream or ointment (such as Sudocrem or Metanium) can help to soothe discomfort.
Other helpful tips can include changing wet or soiled nappies swiftly, checking the nappy fits correctly, allowing the baby to go nappy-free where possible, and avoiding soaps, bubble baths, talcum powder and fragranced wipes. In more serious cases or if the problem persists, the patient should be referred to their GP, as antibiotics or other medication may be needed.
Also known as seborrhoeic dermatitis, this is common in infants but can also affect adults. The main symptoms are greasy, scaly patches which usually appear on the scalp (but can sometimes be found in other places). It’s not contagious and usually clears up on its own, but simple steps such as using an emollient and washing hair with a gentle baby shampoo (if on the scalp) may help.
Parents should be advised not to pick at the scales, as this can lead to infection, and see a GP if the cradle cap is severe, bleeding or does not improve with treatment.
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