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Thursday 7 September 2006, 3.00-3.30pm
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Programme 6. - Childhood Health


THURSDAY 07/09/06 1500-1530








Hello. New shoes, new jumpers for goalposts, a new school year. Are you happy to get the kids off your hands or have you sent them back with a heavy heart to face the challenges and stresses of the classroom?

In today's programme, which is by the way a change to the one advertised, we're taking your questions about the health of our schoolchildren. Are you worried that their diet will suffer from eating or not eating school meals or that they'll pick up infections from crowded classrooms and those frankly less than hygienic shared facilities? Or is your concern about children who may struggle with the rough and tumble of school life and may become stressed and disturbed as a result?

Some of these issues are as much psychological as physical and there are not always easy answers. But here to help and advise is Dr Ann Robinson, she's a London GP and a mother herself who's been through it with her own children. It's not easy, is it, what's the secret to surviving children at school would you say Ann?

I don't think they come with a guarantee that it's going to be easy and someone once said to me - Small children, small worries, big children, big worries. There's no doubt about that. I certainly don't have the secret of survival, I'd patent it if I did but I think the one tip I'd say to parents is it's not about you, it's about your child and a lot of our anxieties are about ourselves, they're really not about the child at all.

Interesting first thought. Let's go to our first caller and we'll go to Nicki and Nicki's in Dorset, has a daughter with impetigo. That's quite horrible isn't it, what did it look - or does it look like?

Are you - sorry - are you talking to me?

Sorry Nicki, yes, yes.

She's - just to give you a bit of background - my daughter finished or started a course of antibiotics on the 8th July, just before the end of the term, just for five days because she had impetigo, which is very sore and inflamed blisters, which crust over and just spread and spread. And this didn't seem to improve much but after going back to the GP and finishing her antibiotics after five days she was given some fusidic cream which then seemed to clear the condition. But two weeks ago it has come back with such a vengeance and I can't tell you how aggressive it's been - all the way up the back of her leg looks like it's been blow torched, it's raw, red and she's now on a two week course of the same antibiotic - flucloxacillin. And it is improving but by no means has it gone and I was just thinking where do we go from here.

Did you say how old your daughter is?

She's 11 years old.

And so at secondary school?

She's in a prep school which goes up to age 13.

And has term started?

Yes it started yesterday.

And sorry is she at school or have you kept her off?

She's gone to school because it's now drying but this is our first 12 days of antibiotics and it's looking much, much better but it doesn't look as if it's on its way out altogether.

Okay, let me hand you over to Dr Ann Robinson, how can we help Nicki?

Hi Nicki, thanks for giving such a good summary really of what impetigo is. As you're aware but maybe not everyone is it's a really common bacterial skin infection where breaks in the skin, which could be little cuts or can be spots of eczema or other inflamed skin, they get infected by a bacteria called staph or staphylococcus. The staph is in the air but it also lives in our noses. And there are a few things that your daughter can do, I mean it's great that she's having a two week course of antibiotics this time because hopefully that will clear it. You're right to have sent her back to school now because she's 11 and as you say the crusts are now drying up. If she were four we would say keep her off for a bit longer because four year olds pick the scabs and then they can just flick them around the classroom and infect other people. But at the great old age of 11 she hopefully won't be flicking her crusts around the class. I don't think. So certainly cleaning the skin, sometimes using an antibiotic cream, as you mentioned, helps but if it's widespread you need the oral stuff, like flucloxacillin, that's the best one and you need the two week course often to clear it. Now the thing is to stop it coming back you need to really ask your GP to consider whether it's worthwhile taking a swab, a little test, just from the inside of the nose of each member of the family because someone in the family, it may be your daughter but it may be someone else, is the reservoir for this bacteria and perhaps if it's in your nose, let's say, you can use a cream for a week or so which will get rid of it. That will stop the endless cycle of impetigo. And the other thing your daughter can do is try and make sure that if the impetigo happens on areas of skin which are broken, either because of eczema or because of cuts, that you try and get the skin as clear as possible. So if it's eczema, even when the impetigo's gone, go to the GP and try and get the eczema cleared and if she does have any open cuts or anything try and keep them covered over while she remains a bit susceptible.

Yes I will do. I'm just - it just seems to have come back the second time so aggressively and I've been told that the flucloxacillin is the strongest antibiotic to deal with impetigo and I was just worried if it's going to come back again, I don't think any mum likes giving her children antibiotics but obviously they are necessary, and I really didn't know what to do from that point on. Yes we'll keep her skin clean. Two of the girls in her class before the end of term did have impetigo, so I think that's where it's come from but I hope it doesn't start a vicious cycle again.

Well it shouldn't do. And if it comes back and it isn't healing quickly your GP should take a swab of the weeping crust because just occasionally the bacteria are not sensitive to flucloxacillin and you need a different one.

Thanks very much for that call Nicki and just on that, obviously Nicki sent her daughter back in and all hopefully will be well, but is there a general rule of thumb would you say Ann about when you should send children with what are after all contagious infectious diseases back to school, is it when they feel as though they're better or should you add on a day or two extra, which is tempting to do but then again if you're working it's difficult to keep children at home for a great length of time?

Yes it's difficult to know sometimes and Nicki, interestingly, has said that the impetigo had come because two girls had it in school and really impetigo is incredibly infectious and kids with weeping limbs shouldn't be in school, it's not really fair to the other kids, so they need to wait until the impetigo crusts over. But we're often a little bit erratic in our advice to kids, so the things that are by far the most infectious are coughs and colds, so spluttering children, once you've got endless streams of infected snot pouring out of their noses unchecked and diarrhoea and vomiting. Now no one sends a vomiting child to school but quite a lot of kids do go to school with residual diarrhoea and the thing is if they're not old enough to wash their hands properly or if there's no soap in the toilets, which there often isn't, they spread it round the class. Now really the diarrhoea and vomiting and the coughs and colds are the things you should keep your children off for and obviously they need to stay off school for a week if they have chicken pox. A lot of the other things that we get very fussed about like conjunctivitis is not quite as infectious as we make out.

Thank you very much. So you're really we have to be socially responsible and coughs and colds really do spread like wildfire around the classroom. Okay, thanks very much. We'll go to the problem of head lice and Jacky, who's got head lice in the family Jacky?

My daughter's got head lice and frequently I get them off her and I was quite interested in the bit about contagion because that's part of my question really - how do you prevent it as well as how do you cure it? There are two different types of lotions that you can get - poisons or apparently one that drowns the lice - and I've been told that they can be resistant, particularly in cities. I've also been told that they're carcinogenic, so that puts you off using them all the time.

Right well let's get a heads up on head lice. Ann, perhaps you can tell us how common head lice are to start with - pretty common?

Well I think any parent who thinks their child hasn't had head lice probably just hasn't looked hard enough. It's practically universal. And the reason is because they're incredibly well adapted to living on our scalps, so the human head lice - head louse one should say - jumps on to the scalp of your child because they've had their head close to another child and it digs in and it feeds off your child's blood, by making little holes in the scalp. And then they get so happy and they have rampant sex on your child's scalp and they lay a whole load of eggs and a week later more lice hatch out and what's left are what we call nits, which are the things we normally see, which are the empty shells which are left behind after the head lice have jumped out and usually transferred on to someone else's head or colonised your child's head. Now by the time you see signs of head lice, which is the child scratching their head and often they've got a rash at the nape of their neck, often the head lice have been in your child's head for at least two months. By the time we find them they're well ensconced and very happy and just finding the nits doesn't necessarily mean actually that there are still active head lice there.

So having said all that you need to comb through your child's head, using conditioner and one of the little special combs, to identify whether there are actually lice there and if there are it is really your social responsibility to get rid of them, both for your child's sake and the sake of every other child in the class. Now it's a very good question as to what works and what doesn't and there's quite a lot of evidence now. Probably combing through very regularly with conditioner and a nit comb does help and we can talk about prevention because it certainly helps with prevention. Leaving conditioner on for a long time probably helps, it's possible that they don't like the conditioner itself - so that's all good. And then there comes the questioner of do you use chemicals or not and there's sort of big, to me, a rather kind of strange thought that because you buy it in a health food shop and it's called either tea tree oil or a mix of essential oils that it's by definition harmless. But we don't have the evidence to say that they're harmless and if they work and if they're toxic to these rampant head lice they might be toxic to your child too, there is always that possibility. So nobody wants to use them but I think you have to get rid of the lice and the products that probably work the best are the ones that contain malathion. And if it were my child or when it's my child or one of my children I use one of the malathion products.

I use malathion in the garden for garden pests, are you talking about the same chemical?

Same stuff.

And it is as safe as it needs to be to put on your child's hair?

Well they're not ingesting it, they're not drinking it hopefully, they're not having it everyday with a bit of luck it'll only be about five times in their whole life, it's get rid of the mites and then you don't have to keep reusing something.

Jacky, I hope that's going to be helpful, thank you very much for raising the question, we got quite a lot more than we bargained for, I think, in that answer. But we've got an e-mail from Jill, I think this is rather good news, she says her daughter had head lice continuously until secondary school and then suddenly they went away and she hasn't them since and she's wondering why that might have happened, I'm sure she's very pleased but she's wondering why, would there be a reason for that?

Well two things come to mind. Firstly, it's possible teenage girls put their heads together less than little girls...

Oh I don't know.

They mostly speak on to mobiles now don't they and texts and things, they don't really talk to each other so much anymore. And also I wonder if she didn't start using conditioner round about the age of 11 and as we said that might have a useful effect.

Okay, thanks for that. Let's go to Jane, she's in Eastbourne and is concerned that her daughter has warts. Warts on the hands and the face Jane?

Yes that's right, she had her first wart nine months ago, it started on one thumb. We now have a crop on that thumb and extensively over both hands, up the forearms, both arms and around the bottom of her lip. And we've tried - we've only been treating one hand because we didn't want to over treat I suppose really, I certainly didn't want to touch her face. And we've used duct tape, we've used paints, we've used the canister type applications but it's quite difficult to do any of these things with a four year old because often you put the duct tape on and it's off five minutes later.

Is she at school?

Starts next week.

Is that what's brought it to a head in a way?

It has because she doesn't want to be the wart girl at school.

Is she a bit self-conscious or is it more you're self-conscious on her behalf?

No she is quite self-conscious. She's been quite lucky at the nursery she was at the little boys and girls were absolutely fine and she was quite confident there, I think it's just meeting new people and she's conscious of it I think.

Well let's talk about dealing with the warts first, Ann what would you say?

Jane can I ask you - how long ago was it that you first noticed any warts?

Nine months. We didn't go to the GP initially, I kind of thought - well I'd heard that they sort of go and as they got more extensive then went to the GP and he suggested the duct tape and we tried that and then sort of progressed on to other things from there.

Right, well I mean it's really good you've raised it, it's a common problem. Warts, verrucas and little things on the hands and face called molluscum are all caused by viruses and eventually your child - your daughter's immunity will kick in and she will clear them. But the average is 6 to 12 months and you're at 9 months now. You've probably only got another three months to go max before they just all spontaneously disappear and of course you get the odd person who you know they last a bit longer but generally within a year they've gone and then she'll probably never get another one again.

Is that with or without treatment they tend to go after six to nine months?

Oh yeah with or without treatment. So if you can hang on in there you're probably coming towards the end of it anyway and any treatment you do now you may well think has got rid of the warts but they may be on the point of going anyway.

Well I think funnily enough the ones we've treated if anything look worse than the other ones.

I mean that's an interesting point as well because the only way to destroy warts, verrucas and molluscum is to physically destroy them and that's why you mentioned duct tape, which someone noticed that if you put over this very strong tape and then pull it off or you use liquid nitrogen or you use what you used which is the sprays and paints which all contain a sort of dilute aspirin, they all work by destroying it but they often affect the surrounding skin as well and they cause quite a lot of irritation and some of the techniques for removing them can cause a bit of scarring. Whereas if you leave them to get better on their own they won't scar and they won't cause any residual problems. So I would hang on in there if I were you.

What about this question of teasing just to finish off on?

It's obviously a very good sign that your daughter was fine at nursery and it's the same kind of kids that go to primary school as went to nursery, so there's no reason to think she'll be teased at school. If she is teased - I mean there are lots of children who get teased about all different things, you can't possibly correct for all of them and sometimes it's very random anyway. I think just boosting your daughter's self-esteem and telling her to tell you if she has any problems and then telling the class teacher to address it, I wouldn't worry too much.

Hope that's been helpful, thank you very much for the call. We'll go to Stella, Stella Todd's in Kent with a four-year-old granddaughter who is bedwetting. Back to bedwetting or has she always been a bedwetter and how does it tie in with school Stella?

Back to bedwetting. She is now five but she was only four and a bit when she started school. But it coincided, starting school, with moving house and daddy had unfortunately left the year before and we just wondered if all these three things contributed to the bedwetting again.

You may have got there in one with your assessment Stella. So really she's had quite a tricky time. So let's talk about actually dealing with the bedwetting though, I mean she's five, I have to remember back to my boys when they were five and I was expecting bedwetting and I got bedwetting and it was no big surprise. So she's not that old yet anyway but if it's a return to bedwetting that may be the issue. Ann, what can Stella and her daughter and family do for the granddaughter?

I mean you're absolutely right Barbara, a child who's been totally and reliably dry for some period of time and then starts wetting the bed basically it's either a urine infection or anxiety and distress or sometimes a bit of both. So I think the most practical thing to do is - is it your daughter's child who's bedwetting now... well we'll assume it is, I don't think we're getting the answer back on that one. But anyway the most important thing to do perhaps is to take a urine sample from your granddaughter to the GP to have it checked for infection. Sometimes the GP will want to see the child but it's not always necessary, you can just drop it in and then get the results about a week later usually.

Drop the urine sample, not the child in.

Yes, I don't think the GP will thank you for leaving the child there for a week. So drop a named labelled urine sample in and get the result a week later or take the child to the GP to be checked for urine infection. But obviously urine infection normally gives the signs of a high temperature and tummy pain, so normally you have some kind of heads up that it's an infection. Anyway once you have excluded an infection you have to say that your grandchild is showing some signs of distress. There's some practical things that you can do to try and stop the bedwetting - so limit drinks in the evening, to lift the child before the adult in charge goes to bed and to give lots and lots of praise for any dry nights and sometimes a star chart helps as well. And obviously there are a lot of things that have happened to your granddaughter that you can't do anything about - she's moved home and the father, unfortunately, left home and she's had to adapt to a new school - so the key thing is to really bolster her self-esteem, make her feel fantastic about herself, don't focus too much on the bedwetting and the chances are if you can make her feel really good and secure and comfortable that the bedwetting will just stop.

Sound advice, hope that's helpful Stella. To Fareham now and we'll talk to Diane Girling, who's got a daughter with a few things you're a bit worried about Diane, just fill us in briefly will you?

Hello. Yes my daughter's 11, just gone up to senior school, and she is having problems with stomach aches and feeling sick, that's been going on for about five and a half years, particularly related to getting stressed about going to school and also more recently it's become headaches and her eyes hurting as well. Having been to the GP all we've got back is they think it's stomach migraine, which is not something I've heard from - heard of before and no practical advice how to help this.

Could it be stomach migraine - it's not something I've come across Ann but I daresay you have as a GP?

Yeah stomach or abdominal migraine is quite a common condition, it's the childhood variant of migraine that many people suffer from and a lot of kids who get abdominal migraine do go on to get the headachy kind of migraine and it's due to be thought to the same sort of thing which is a sensitivity to circulating chemicals in the bloodstream that set off the whole pain pathway really but in the child they get the tummy ache more than the headache. I don't think, to be honest, the label is really the key thing, the key thing is that your daughter's obviously got a longstanding problem which is incapacitating her and distressing her and you and therefore is worthy of attention. If it's been going on for five and a half years and she's physically in good shape the chances of you finding an underlying physical condition are going to be very, very small. And you could argue that really there's not a lot to be gained from over medicalising this problem, once all the normal things have been excluded, which presumably your GP will have done. So I think that it sounds as though your daughter needs some help with dealing with this because abdominal migraine is just a label we give to something we don't really understand very well and we can't help very well, which possibly explains why your GP hasn't given you anything practical to do about it. And I think if it were my daughter what I would want to do at this stage is to ask for a referral to what they loosely call child and adolescent mental health, and that's the kind of umbrella organisation in each area which coordinates lots of psychological therapies and it sounds to me as though your daughter would benefit from that.

Hope that helps. A very quick call, if we can squeeze it in, I think it's the dreaded question about what to eat at school and how to make sure your children get the right diet. Liz in London, yes, hello Liz.

Yes hello. My little girl starts school on Monday, she's four. She was born low birth weight, I've always been quite worried about her nutrition. She doesn't like sandwiches but she loves chips, so I was wondering about the benefits of packed lunches over school lunches.


Oh it's a hairy one and I wish her loads of luck next week and wish you lots of luck as well. Basically it doesn't matter that much. They have five meals at school in the week and they have at least 21 meals in total, so we're only talking about a quarter of the weekly meals that she's going to get being at school and they're not at school very much, as we know, loads of holidays, so altogether about a sixth of the meals that your daughter will have over a year will be at school - five sixths of them will be at home. So really the onus is on you, I wouldn't worry too much.

Thank you very much indeed. More sound advice, don't worry too much about food. We'll have to stop there, time is up, it always runs out on us. Thanks to Dr Ann Robinson, thanks to all of you who have called in today and over the past few weeks. If you'd like further information call our help line - 0800 044 044.

This is the last in the current series but if you want to listen again to today's programme or indeed to any other edition of Check Up then you can go to our website, just follow the prompts to Check Up where you can hear them all again. And with that in mind we're very interested in some feedback, if there's been anything you've heard in past programmes which has been particularly helpful to you we'd like to hear from you, perhaps you've been alerted to the need to seek medical treatment or information about a new treatment that's worked for you. If there's anything you want to tell us, call us on - well indeed e-mail or write to Check Up at BBC Bush House London. Till the next time, bye, bye.


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