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From unpleasant childhood ailments such as head lice to the modern-day perils of cyber-bullying and grooming, growing up can be a tricky time for today’s children...

 

 

Community pharmacy is well placed to provide trusted health and social care advice and signposting to youngsters and their families – so check you are up to date on the latest thinking by using this brief guide to child and teenage health and wellbeing.

Acne

Affecting eight out of 10 teenagers, acne is usually dismissed as a cosmetic problem, although it can have a profound effect on emotional wellbeing and accounts for more than 3.5 million GP visits in the UK each year. The skin condition is not caused by poor hygiene, while excessive washing with abrasive cleansers can actually worsen it by stimulating sebum secretion. Benzoyl peroxide and antibiotic preparations form the mainstay of treatment, although some experts have questioned the use of antibiotics in acne due to antimicrobial resistance, and recommend topical retinoids instead. Teenagers should be encouraged to persist with treatment as it may take several weeks or months before an improvement is seen. The use of gentle cleansing and moisturising products can be recommended to counteract any dryness and irritation resulting from the treatment.

Bullying

These days, children can be subjected to bullying anywhere – at school, at home and, increasingly, online via social networks and mobile phones. In 2012/13, 4,500 young people contacted ChildLine about online bullying (often known as cyber-bullying). A new Safeguarding Children toolkit, produced by the Royal College of GPs and the NSPCC, urges healthcare professionals in contact with children and families to be alert for the signs of cyber-bullying and other forms of abuse, and to be able to provide help, either directly or by signposting and referral to other services. To download the toolkit visit: rcgp.org.uk.

Chickenpox

Chickenpox can usually be managed with self-care advice, as taking an infected child to a GP may risk spreading the virus to vulnerable patients. Parents can be reassured that it is normal for new spots to keep appearing in waves, although medical intervention should be sought if the blisters become infected or the child has chest pain or difficulty breathing. Itching is usually the most unpleasant symptom and can be soothed with a cooling gel or the antihistamine chlorphenamine maleate at bedtime. Putting socks over a child’s hands at night and keeping their fingernails short can help to discourage scratching. 

Drug and alcohol abuse

Teenagers and young people often come under peer pressure to take drugs or binge drink. FRANK, the confidential drugs advice service, recommends that they think about how they will respond to situations before they arise by:

• Asking themselves if those offering them drugs or alcohol have a motive

• Saying no clearly and firmly

• Focusing on their own opinion of themselves

• Looking out for their friends.

For confidential advice and facts, pharmacists can refer young people to talktofrank.com.

Eczema

Atopic eczema affects up to one in five children, but threequarters are eczema-free by the age of 16 years. To counteract the itchiness, the National Eczema Society (NES) recommends cotton clothing and bedding, using a non-bio washing powder, avoiding fabric conditioner and ensuring a cool bedroom environment. Aqueous cream BP should not be used as a leave-on emollient because it contains the irritant sodium lauryl sulfate (SLS), which can damage the skin barrier.

FGM

The NSPCC estimates that over 20,000 girls in the UK are at risk of FGM (female genital mutilation) – considered by the United Nations to be a form of child abuse and a violation of human rights. In the UK, it is illegal to perform the procedure or send a child abroad for it. Pharmacists should be aware that girls from practising communities are most at risk around the age of eight and during the summer and Easter holidays. If they have any suspicions, they should report them to the police, social services or the free 24-hour NSPCC helpline (0800 028 3550).

Grooming

The signs of grooming aren’t always obvious and can easily be mistaken for ‘typical’ teenage behaviour, but according to the NSPCC, children who are being groomed may:

• Be very secretive, including about what they are doing online

• Have older boyfriends or girlfriends • Go to unusual places to meet friends

• Have new things such as clothes or mobile phones that they can’t or won’t explain

• Have access to drugs and alcohol.

Pharmacy staff delivering sexual health services to young people may be in a position to spot these signs and signpost appropriately.

 

Head lice

As well as advising parents on the most effective head lice treatments, community pharmacists are well placed to help refute head lice myths and advise on treatment failure. Parents may suspect that a head lice product hasn’t worked properly when, in fact, the instructions were not followed correctly, not everyone in the household was treated at the same time, or if an itchy scalp has another cause. To avoid causing stigma, experts recommend that pharmacists use the term ‘infection’ rather than ‘infestation’.

Impetigo

The common bacterial skin infection, impetigo, affects around one in 35 children up to four years of age and one in every 60 children between four and 15 years each year, says NHS Choices. Non-bullous impetigo, which normally occurs around the nose and mouth, is the commonest type, while bullous impetigo, affecting the trunk, usually affects babies. The infection usually clears up without treatment within two to three weeks but antibiotics are recommended to prevent spreading. Regular hand washing, not sharing flannels or towels and keeping away from school for 48 hours can help minimise transmission.

Junk food

National survey data show intakes of saturated fatty acids, salt and added sugars by adolescents are above recommended levels. Along with inactive lifestyles, diets high in ‘junk food’ are blamed for the fact that one in five 11-15 year-olds in the UK are obese, according to the National Child Measurement Programme. In addition, unhealthy eating habits mean that many youngsters have low intakes of vital nutrients, including vitamin A, iron, calcium and magnesium. Following media coverage of the link between obesity and sugar, Public Health England has launched ‘Sugar Swaps’ – a new Change4Life campaign to encourage parents to replace high calorie, sugary foods in their children’s diets with healthy alternatives. More details can be found at nhs.uk/change4life.

Laxative abuse

Beat, the eating disorders charity, is campaigning for restrictions on the sale of laxatives, following research showing that more children and young people are using these medicines as weight loss aids. The charity would like to see laxatives reclassified as pharmacy-only medicines, as well as a minimum sale age of 16 years, pack size limits and warning labels. The MHRA rejected the appeal for reclassification in October 2014, although stronger pack warnings could be introduced soon. Laxatives do not aid weight loss as they work on the lower bowel, while continued misuse can cause dietary deficiencies and organ damage.

 

 

Meningitis

The Meningitis Research Foundation (MRF) warns that babies and young children are most vulnerable to meningitis, followed by young people and students because they encounter new bacteria when they move away from home. The charity urges young people to receive the MenC booster vaccination at least two weeks before starting university, to familiarise themselves with the symptoms and look out for their friends. Pharmacists should advise families and young people not to wait for a rash if they suspect meningitis but if a rash has developed, the ‘tumbler test’ should be used (spots do not disappear under a glass).

Nocturnal enuresis

NICE guidance states that nocturnal enuresis (bedwetting) can be associated with daytime urinary incontinence, bowel problems, developmental or psychological problems, and sleep disordered breathing, while research suggests there is a genetic predisposition. Behavioural measures, including adequate fluid intake and voiding before bed, may help resolve the problem, along with rewards for agreed behaviour rather than for dry nights, followed by an alarm system. If these measures fail, then antidiuretic medication may be prescribed, while absorbent products designed to look like underwear can be used alongside treatment.

Odour

Body odour (bromhidrosis) becomes more noticeable during puberty due to the surge in androgens. Daily washing is essential, as is changing clothes every day and using an antiperspirant. Shaving the armpits may also help, as the hair provides a greater surface area for sweat and stimulates bacterial growth. It is also a good idea to avoid garlic, spicy food and alcohol, which can trigger sweating. If these measures prove ineffective, pharmacists can recommend a solution containing chlorhexidine 0.05% or aluminium chloride 20%. Proprietary preparations are also available.

Painful periods

Between 50 and 90 per cent of girls suffer from painful periods (dysmenorrhoea). Cramping can usually be managed with NSAIDs, such as ibuprofen, naproxen or mefenamic acid, but if the pain is severe a GP may also prescribe hormonal contraceptives. Heat therapy in the form of packs or hot water bottles can also help to alleviate cramps and may enhance the benefits of NSAIDs, while those who take regular exercise report less menstrual pain.

Rickets

The bone deformity disease rickets has been making a comeback in recent years due to declining vitamin D levels in children and infants. Sunlight is the main source of vitamin D, essential for the healthy formation of bones and teeth, but the latitude of the UK and its unreliable weather means it is only possible to synthesise the vitamin in the body between April and October. New NICE guidance advises pharmacists to increase access to affordable vitamin D supplements containing the recommended dose for ‘at risk’ groups including children under five years old and pregnant women.

Rickets has been making a comeback in recent years due to declining vitamin D levels in children and infants

STIs

Providing sexual health services, including EHC, the C-Card scheme and chlamydia screening, offers pharmacists an ideal opportunity to discuss contraception and sexually transmitted infections (STIs) with young people. The Royal Pharmaceutical Society advises pharmacists to:

• Be non-judgmental

• Offer young people the chance to talk in the consultation room

• Reassure them that conversations are confidential

• Provide useful leaflets

• Signpost to other local service providers.

Tooth decay

Research by Public Health England shows that more than one in 10 three-year-olds and more than one in four five-year-olds have visible signs of tooth decay. According to the British Dental Health Foundation (BDHF), the main cause of tooth decay is not the amount of sugar and acid in the diet, but how often it is eaten or drunk. To limit the amount and frequency of sugar intake, the BDHF recommends keeping sugary foods to meal-times, checking baby food labels for sugar and using sugar-free medicines. In addition, parents should be advised to start brushing children’s teeth with a fluoride toothpaste as soon as the first tooth appears and to supervise brushing until at least the age of seven years.

Tooth decay in young children remains a problem- suagr in the diet is to blame

Unplanned pregnancy

The under-18 conception rate in England and Wales is at an alltime low, yet teenage pregnancies remain commoner in the UK compared with the rest of Western Europe. NICE guidance released last year called for greater access to a wider range of contraceptive methods for under-25s, while an American study published in October 2014 found that long-acting contraceptives reduce teenage pregnancies by 79 per cent. Through services like EHC and the C-Card scheme, community pharmacy has already demonstrated that it has a key role to play in reducing teenage pregnancies through providing and advising on contraception, while the forthcoming POM to P switch of ellaOne (ulipristal acetate), which is effective up to five days after unprotected sex, should further improve access.

Young people need better access to contraception to avoid unwanted surprises...

Vaccinations

In September 2014, two changes were introduced to the national childhood immunisation schedule. The HPV vaccine was reduced from three to two doses, as the antibody response has been shown to be just as effective with two doses and the nasal spray flu vaccine was extended to all children aged two, three and four years. Pharmacists are well placed to reassure parents of the safety of vaccinations, as well as provide advice on managing stress associated with them. An evaluation of last winter’s flu vaccination pilot scheme of children aged four to 11 years in Cumbria revealed that pharmacists had carried out 80 per cent of the vaccinations, indicating that pharmacy can play a big role in helping to implement the nationwide roll-out of the flu vaccination programme to all children.

Warts and verrucas

Caused by HPV infection, warts and verrucas affect most people under the age of 20 years at some point. Verrucas are warts that develop on the plantar surface (soles) of the feet, easily picked up by walking barefoot in changing rooms or at swimming pools. Most OTC wart and verruca treatments contain salicylic acid, while home cryotherapy treatments are available. Users may need to be advised to persevere with treatment (which can take several weeks) and will find tips on application and prevention helpful.

Zzzz...

Due to changes in the circadian rhythm during adolescence, teenagers naturally feel alert later at night and don’t feel wakeful until later in the day compared to younger children and adults. In a recent study, the academic performance of teenagers improved when the start of the school day was extended to 10am. Until later school start times become the norm, adolescents can improve their sleep quality by taking regular exercise, avoiding caffeine before bed, and removing mobile phones, TVs and tablets from the bedroom.