Dr Ioannou is regularly contacted to provide expert opinion in child health magazines and online forums. Here is a sample of recent questions and answer with useful information for parents.
MY SIX-MONTH-OLD IS TEETHING. HE IS IRRITABLE ALL THE TIME AND I FEEL HELPLESS. WHAT CAN I DO?
The process of teething varies a great deal between babies. The first teeth usually appear sometime in the first year, often around the age of six months, although may occur earlier or not appear until a year of age. Teething commonly causes no symptoms at all and teeth appear without causing any diffculty. In some babies, dribbling, fussing and chewing on things may be a sign.
If your baby appears unwell or has a fever, it’s important not to attribute this to teething – babies should be seen by a doctor if you are worried. It is also a normal part of a babies’ development to drool and put their hands to their mouths, so don’t be too concerned. A visit to your GP is usually all that’s needed for reassurance.
There are a number of ways you can help relieve discomfort if teething is thought to be the most likely cause. A teething ring can provide a good option for babies to chew on. You can also cool the rings in the fridge (not the freezer) to further help soothe gums.
For babies who have commenced weaning, usually from six months, chewing on foods appropriate for their age will not only provide relief but nutrition too. Raw fruit or vegetables make good finger foods, but do supervise your baby at all times. Teething gels are available over the counter from most pharmacies. These contain a mild anaesthetic, which you can rub on gums, but only for short-term use. Pain relief with paracetamol or ibuprofen can also be used, but I wouldn’t recommend this unless your baby has been checked first, to make sure there are no other causes for the discomfort.
Before you know it, all your baby’s teeth will have come through, teething will be a distant memory and the tooth fairy will appear to start taking milk teeth away.
Smallish Magazine 2017
MY FOUR YEAR OLD IS STRUGGLING WITH HAY FEVER, WHAT CAN I DO TO HELP HER THROUGH THE SUMMER MONTHS?
Hayfever, seasonal allergic rhinitis, is a very common condition affecting children and adults. Children may have an itchy, blocked or runny nose, sneezing and red, watery and itchy eyes. Symptoms can vary from mild to severe and are caused by the immune system reacting to allergens in the air such as pollen from trees and grass. Different types of pollen are present throughout the year and grasses are the biggest culprits during the summer months. Avoiding exposure to pollen can be difficult especially on sunny days when children and parents want to be out doors. Keeping windows closed in the car when driving with your child, avoiding going out on very windy days and after thunderstorms, wearing sunglasses to protect eyes, not hanging clothes outside to dry, staying inside when the lawn is being mown are a few suggestions to avoid pollen exposure. However, if symptoms are more troublesome medications are usually also needed. Antihistamines, steroid nasal sprays and eye drops are all commonly used, safe and many varieties of these medications are available without prescription. In many children hayfever can become very disruptive affecting sleep, development, concentration and school performance in older children and so it is important not to ignore the symptoms. Your GP or paediatrician can assess the severity, examine for other causes and associated allergic conditions, such as eczema and asthma, and recommend appropriate treatments. In some cases assessment by a specialist in paediatric allergy and skin prick tests or blood tests may be required. If you are concerned do seek help and advice as usually simple avoidance measures, using antihistamines and lots of tissues will be all that is needed.
Smallish Magazine 2017
MY 4 MONTH OLDS HEAD ALL OF A SUDDEN SEEMS TO BE TIPPING TO ONE SIDE… HAVE NOT NOTICED IT UP UNTIL THE LAST COUPLE OF WEEKS COULD THIS BE TORTICOLLIS OR SOMETHING ELSE?
Many thanks for your question and I agree that the description of your baby’s head tipping to one side could be torticollis. Torticollis is common in infants and can be present from birth or appear later. A baby’s head turns preferentially in one direction and may have tight neck muscles on one side. An assessment by your GP or paediatrician is very important to look for any other rare underlying causes, especially if this has only occurred recently. In most cases all that is required is simple stretching exercises for tight neck muscles, tummy time and your GP may refer you to a children’s physiotherapist. Any new symptom in an infant does need to be checked by your GP and usually this is all the reassurance needed. I hope this helps guide you and if you have any further questions relating to your baby’s specific case, please to contact me.
I’M CONCERNED THAT OUR 16 MONTH OLD ISN’T WALKING YET. WHAT ARE THE MAIN REASONS BEHIND LATE WALKING, AND HOW SHOULD WE HANDLE IT?
Every child is different and delays reaching milestones are not always a sign of a more significant problem. Many children start walking around or just after their first birthday, however, if a child is not walking by 18 months old, it is time for a more detailed assessment by a paediatrician. Parents should not panic as everything could still be normal, and it may not be an indication of any underlying health problems.
Common causes of delayed motor milestones include hereditary family traits – for example, the parents were late walkers, and these babies often bottom shuffle rather than crawl. Late walking can also be associated with having low muscle tone or hypermobile joints. Other causes include neurological issues affecting muscle tone, inherited conditions affecting muscle strength or bones and hip joints, all of which may be identified earlier than 16 months old. If all other aspects of development are ne and there are no other concerns, your GP may just watch and wait until your baby reaches 18 months old. Usually health visitors and GPs monitor development, and they may involve physiotherapy to help motor development if necessary.
Once your baby approaches 18 months old or other concerns emerge – especially delay in other aspects of development – an assessment by a paediatrician is recommended. In some cases a paediatrician may carry out investigations that could include blood tests, genetic/chromosome analysis, and rarely brain imaging. The majority of children who are not walking at 16 months will just be late walkers with no underlying problems. If you are concerned, see your health visitor or GP.
Smallish Magazine 2016
MY CHILD HAS JUST BEEN DIAGNOSED WITH SLAPPED CHEEK DISEASE. WHAT IS THIS AND SHOULD I BE CONCERNED?
Slapped cheek disease is a viral infection caused by the virus Parvovirus B19. The name comes from the typical appearance of the rash, which usually gives a blotchy red appearance of both cheeks ( slapped cheeks).
The virus is spread through inhaled droplets in a similar way to colds and flu viruses, which is why there are often outbreaks in nurseries. Children with runny noses, coughing and sneezing are excellent spreaders of the virus.
Early symptoms are similar to a cold, and include a runny nose, sore throat and a temperature. After a few days the distinctive red rash develops, that gives the slapped cheek appearance, and this can also spread to other parts of the body. This rash can look quite alarming and can last for a few weeks, sometimes fading and reappearing, but there are no long term harmful effects in otherwise healthy children.
The virus can sometimes cause complications in children or adults with a weakened immune system or blood disorders such as sickle cell anaemia. Most adults will be immune, as they will have been exposed to the virus in childhood, even if they did not develop symptoms. Women in early pregnancy who develop symptoms such as the rash, or who come into contact with someone who is thought to have the virus may require a blood test to see if they are immune already and if not may require closer monitoring such as another scan.
There is no treatment needed, and children should be encouraged rest, drink plenty of fluids and paracetamol or ibuprofen for children may be needed to help with sore throats and temperatures. A check up by your GP, to confirm the diagnosis and reassure you, is usually all the is needed.
Smallish Magazine 2016
MY BABY KEEPS BRINGING UP HER MILK STRAIGHT AFTER I FEED HER. IS THERE ANYTHING I CAN DO TO STOP THIS HAPPENING?
Bringing up milk after feeds is very common in babies and is usually not a cause for concern. Regurgitation and posseting are terms used to describe the effortless, non-forceful return of milk out of your baby’s mouth. Nearly all babies posset small amounts of milk as they bring up wind, whereas regurgitation of larger volumes of milk usually indicates gastro oesophageal reflux. Vomiting describes bringing up milk in a more forceful way and is also very common in babies and also commonly due to reflux.
I see many babies in my NHS and private practice referred due to concerns regarding reflux. It is normal and very common in both breast and formula fed babies. In most cases symptoms are mild and can be managed without medicines. Holding your baby upright after feeding, ensuring she has burped, avoiding overfeeding and investing in a good supply of muslin cloths, will usually be all that is needed.
If your baby is putting on weight, you usually don’t need to do anything and can be reassured that symptoms gradually improve over the first year. Thickening milk may help with frequent regurgitation and if discomfort during and after feeding is a problem your GP or paediatrician may recommend trying an anti-reflux medication. If medicines are prescribed, their use should be reviewed regularly aiming to stop when symptoms are stable.
In some babies that are vomiting a lot and showing symptoms of reflux, allergy to cow’s milk protein could be the underlying cause. Colic and crying, frequent and explosive poos or constipation, blood and mucus in the poo and eczema are all other indicators that this may be the issue. Excluding all cows’ milk based products from the mother’s diet, if breastfeeding, or using an alternative specialist formula, in formula fed babies, will be recommended for a trial period to see if the symptoms improve.
A review by your GP or paediatrician is important if your baby is vomiting frequently. They will check your baby is gaining weight, having frequent wet nappies and check that there are no worrying associated symptoms that might indicate an underlying problem. Things to look out for that need more urgent assessment include green or blood stained vomits, blood in the poo, a swollen tummy, drier nappies and projectile vomiting after every feed especially if your baby is losing weight. If your baby is vomiting and has a fever you should always take her to see a doctor as this may indicate a serious infection, especially in younger babies.
Most of the time, babies won’t exhibit any of these worrying symptoms and bring up milk whether forceful or not is likely to be due to reflux and will improve as your baby matures.
Smallish Magazine 2017
MY BABY’S NOT EVEN A YEAR OLD AND HAS ALREADY HAD THREE OR FOUR COLDS. SHOULD I BE WORRIED?
There is no need to be worried, this is very a very common reason why I see babies and children in my clinic. Colds are caused by viruses that are circulating all year round, although tend to be more common in the winter months. Toddlers can have as many as 12 colds in a year usually concentrated in winter and becoming less frequent in summer months. It can feel like one illness runs into another, with symptoms including a runny or blocked nose, sore throat, fever, coughing and sneezing. However, usually colds get better on their own, within a week. If toddlers have a persistently runny nose, this can sometimes be a symptom of hay fever.
Fighting off frequent infections isn’t a sign that your child is unhealthy in the majority of cases, but rather that they are building up a healthy immune system. Babies inherit some immunity from their mother and during the first year this wears off as babies build up their own immunity.
Very young babies may struggle a bit more even with a simple cold as they have smaller nasal passages and airways. Saline drops to the nose can help clear mucus and ease breathing in babies. As colds are caused by a virus, they usually don’t require treatment by antibiotics. Encourage your baby or toddler to drink plenty of fluids to keep well hydrated and lots of wet nappies are a reassuring sign.
It is worth buying a good thermometer to check your child’s temperature. A temperature above 37.5 C is considered a fever. In babies less than three months old, a temperature above 38 C could be a sign of a more serious infection such as a urinary tract infection or chest infection and so should always be checked by a doctor. Even with a normal temperature, if your baby has symptoms that you are concerned about such as fast or laboured breathing, drowsiness, a rash, cool hands and feet, reduced feeding and drier nappies, it is very important to see a doctor. Infant paracetamol or ibuprofen are helpful in alleviating pain and discomfort associated with colds and fever.
There is a vaccination against common strains of flu virus. Currently in the UK, this is given to all two to seven year olds at the start of the winter flu season. It is administered via a nasal spray and depending on the age of your child will be available from their GP surgery or school.
In the vast majority of cases recurrent illnesses in babies and toddlers to do not indicate an underlying problem with the immune system. A visit to your GP or paediatrician for a thorough assessment is usually all that is needed to reassure you.
Smallish Magazine 2017
I’M DUE TO SCHEDULE MY BABY’S VACCINATIONS, BUT HE WAS BORN PREMATURELY, AND I’M NOT SURE WHETHER I SHOULD WAIT UNTIL HE’S A LITTLE BIT OLDER?
If your baby was born prematurely, it is understandable that you may feel he is more fragile and not ready for the first jabs. Although premature babies are more vulnerable to infections they do have a working immune system and are able to mount a response to vaccinations. Premature babies will be most at risk for contracting illnesses, so it is in your baby’s interest to follow the immunisation schedule and protect them from the diseases that they might be most vulnerable to.
It is recommended to vaccinate your baby in line with his chronological age, i.e. age since the day he was actually born not expected to be born. The vaccination schedule is designed to give your baby the best protection from the specified diseases, and the recommendations are based on a child’s immune response at that age. Some vaccinations such as BCG and hepatitis B can be given from birth, but most are given at eight, twelve and sixteen weeks on the UK schedule, followed by further vaccines and boosters doses at a year of age and pre-school boosters after the age of three. Teenagers shouldn’t feel too left out as they will also have vaccines given at 13 years (girls only) and 14 years old.
If your baby is still in hospital at the time vaccinations are due these will be given in hospital so he won’t miss out. Always bring your red book to appointments so that vaccines can be recorded, especially if you are not having vaccines given in the same place on every occasion.
The UK immunisation schedule is very comprehensive, protecting your child from at least 15 different illnesses. The majority of childhood vaccinations are available through the NHS, although some such as the BCG, the vaccine against tuberculosis, hepatitis B and chicken pox vaccines are only available to certain groups of children. Hepatitis B will be given routinely to all babies at eight, twelve and sixteen weeks from summer of 2017. The good news is that this will not require an extra injection as it will be given as part of a 6 in 1 vaccine.
The additional vaccines are available privately, if your child is not eligible through the NHS, and your GP or paediatrician can advise you on how to access these. The Meningitis B vaccine has recently been made widely available for babies at eight and sixteen weeks and a year of age. This protects against the type B group of meningococcal bacteria that can cause meningitis and septicaemia. This particular vaccine commonly causes fever as a side effect and so infant paracetamol is recommended to help with this and you will be advised about this at the time the vaccine is due.
There are not many reasons or pre-existing illness that affect the timing of vaccines, but it is important to discuss any previous allergic reactions or current symptoms your baby might have with your GP prior to the vaccines being administered.
Smallish Magazine 2017
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