As a pharmacist, you’re probably asked for advice by parents on a regular basis. Common baby and child health miseries – everything from colic to head lice – can leave kids in considerable discomfort and parent tired, irritable and upset.
Fortunately, there are products available on the market for practically every minor ailment that affects children.
A raised temperature in a child is caused by the resetting of the body’s own natural thermostat to a higher level. in order to make the body hotter, the blood vessels on the surface of the skin become much smaller to minimise the loss of heat. Once this new, higher setting of the body’s own thermostat is reached, the temperature will be higher than normal. Most parents adopt the attitude that a fever is bad for a child, but this may not always be true. A raised temperature may, in fact, be harmful to any bugs, which are causing an illness and may actually reinforce the body’s own immune system, which is fighting the problem. To reduce a child’s temperature, the child should be stripped down and sponged with a cool cloth. Paracetamol will not only help to reduce the temperature, but will also help to kill any pain that the child may be experiencing.
Sticky eyes or conjunctivitis is the term given to eyes, which are red and sore looking. it is usually easy to diagnose thanks to the distinctive yellow gunge on the edge of the lids, which often causes the lids to stick together after a night’s sleep. Often the infected eye is runny, red and inflamed. The condition isn’t really painful, but can cause a gritty soreness in the eye, especially when blinking. If the infection looks mild, the parent should be advised to simply bathe the eye with lukewarm will, but, if the eye looks more ‘gungey’, then you should advise the parent to go to their GP as a course of antibiotics may be required.
Head lice – a nightmare for parents at any time, but especially in September, when close proximity of little heads at nursery or school allows head lice to move easily from one head to another. (Head lice can’t hop, fly or swim, but they’re easily transferred because young kids tend to put their heads closer to each other.) Head lice can be difficult to spot on the hair, but detection combing is sure to root them out. Suggest to parents that they purchase a special, fine-toothed comb (there are various dedicated head lice combs on the market now) and show them how to use it by coming the hair a section at a time. The process is made simpler if hair condition is used first, as head lice can move rapidly in dry hair. After each stroke with the comb, the comb teeth should be checked for lice. If there is an infestation, then recommend a head lice treatment. It may also be an idea to recommend a specific shampoo or treatment, which is designed to ward them off in the future.
Chickenpox – or varicella to give it its correct name – is one of the most common infectious childhood illnesses. The child will feel as if he or she has a cold or fever, then small pink bumps will spread over the whole body, developing into little water blisters. The child will be itchy and infectious until the last spot is dry. Scratching can cause scarring, so suggest to parents that they dab calamine lotion onto the spots. The child may be more comfortable at home and should not come into contact with pregnant women as exposure to chickenpox can lead to birth defects. If the child’s spots become infected a GP may prescribe an antibiotic cream.
Common colds are – as you know – caused by viral infections and can’t really be prevented, so treatment of the symptoms is really all that can be done. Sore throats and a temperature can be treated with paracetamol and there’s a variety of OTC medicines available. If the child’s nose is sore from blowing into tissues, suggest that Vaseline is smeared on it to bring the child some relief. A humidifier may also help.
Mumps are an infectious disease that’s caused by a virus. There’s no specific medical treatment for mumps but, fortunately, they’re less common now thanks to the MMR vaccination, which is given to most children between twelve and fifteen months, but some parents choose not to let their children have the vaccination, which can put them at risk of mumps, measles and rubella. If a child does get mumps, their neck will be swollen and tender and they may have a fever. They may also experience pain when swallowing and so should be given soft, puréed food and plenty to drink. If the child is feverish, suggest to the parents that they sponge them down with cool water.
Ringworm is a fungal infection of the skin that can affect different parts of the body. A child with ringworm will have roughly circular, scaly rashes on various parts of their body. Some may have blisters, while others will have pus-filled spots. On the scalp, small bumps may spread out to create bald spots. Advise parents to throw out brushes and combs and to ensure that the affected child uses a different towel from other family members. OTC anti-fungal preparations are available, but, if the ringworm is severe, or if it persists for a period of time, suggest that a visit to the GP may be necessary for further assessment.
Scarlet fever is a red rash which starts on a child’s chest and neck and spreads to the whole body, except for their mouth. They will also have a very sore throat and a furry red tongue. The child should be given cool drinks and their food should be puréed. An antibiotic may be prescribed by a GP and this must be taken for 24 hours before a child returns to nursery or school.
Strep throat/tonsilitis is caused by the Streptococcus A bacteria and causes a child to have a very sore throat, high fever and swollen neck glands. As with scarlet fever, cool drinks and puréed foods should be advised. A simple throat swab will reveal whether or not treatment is required and a GP may prescribe an antibiotic, which must be taken for 24 hours prior to the child returning to crèche or school.
Although unpleasant to look at, worms or threadworms are usually indicated by a child scratching their bottom at night. Suggest that the parents look for tiny white ‘threads’ in their child’s stools or on their bottom at night. If worms are present, the nursery or school should be informed and the whole family needs to be treated at once, even if they don’t have any symptoms. That’s because the risk of the infection spreading is very high. Threadworm treatment is targeted at getting rid of the threadworms and preventing reinfection, and usually involves a combination of medication to kill the worms and strict hygiene measures to stop the spread of the eggs. The principal medication used to treat threadworms – mebendazole – is available OTC from the pharmacy but, if the child is under two years of age, you should advise the parents to visit the GP as the recommended treatment usually isn’t the same for this age group as that recommended for other people.
Pain relief for children
Parents often worry about giving their children painkillers, but with sensible advice and reassurance from the pharmacist, the correct use of analgesic medicines will relieve pain in most children.
For mild pain in children aged under three months, paracetamol should be offered. Children aged over three months can, however, be offered both paracetamol and ibuprofen.
Parents should be advised that medication should be given regularly for persistent pain, rather than on an ‘as required basis’. Analgesics should, therefore, be given at regular intervals, with the addition of extra doses for intermittent and breakthrough pain.
Where pain is associated with fever (especially in children over the age of five), dental pain and for control of pain in long-term inflammatory conditions, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are recommended.
Aspirin should always be avoided in children under the age of 16 due to the risk of Reye’s syndrome, a very rare condition that can cause serious liver and brain damage.
Minor Ailment Service
Children under 16 years of age are, of course, eligible for the NHS Minor Ailment Service (MAS).
Many of the illnesses and conditions that are mentioned above, which are often specific to children are covered by MAS. These include: headache, head lice, cold sores, nasal congestion, cough, pain, earache, eczema, sore throat and threadworms.
As a pharmacist you will, of course, understand that the scheme is designed to offer medication to meet an acute need. as NHS UK points out on its website, ‘It is not an opportunity for parents to stock up on free children’s medications – if a pharmacist thinks someone is trying to abuse the system, they can refuse any request for treatment at their discretion.
‘The pharmacist has no obligation to provide branded medication such as Calpol. If there is a cheaper generic version available that is known to be equally effective, it is likely that will be provided instead.’
Nevertheless, MAS provides many parents throughout Scotland with necessary medication free of charge.