Sam Norman: Well, this time of the year that every toddler and baby seems to have a constant running nose and a whole catalog of other ailments. Doctor Su Laurent is Consultant Paediatrician at Barnet & Chase Farm hospitals and the Baby Channels Medical Advisor. She is here to help you get your baby through the ocean and winter flus. Su, it is true, isn’t it? This time of the year kids get poorly all the time, I mean, what’s the commonest cause of --
Su Laurent: It is the classic time for viral infections and the commonest thing children will have will be a cold.
Sam Norman: Right.
Su Laurent: And we partially call it an upper respiratory tract infection, it on early for short. What it is? It is a cold. And colds can affect babies and children in many different ways, they can have just a running nose, they can have sore throats, they can have ear infections, they can have a horrible cough. But personally my third child from the age of two to four, no, probably one to four, actually had permanently snotty nose from October till March.
Sam Norman: Is that a little snot factory?
Su Laurent: White little snot factories.
Sam Norman: Yeah.
Su Laurent: It’s constant dribble, constant snot. And in between times quite well in himself, and then a bit of temperature and then well in himself, but always snotty.
Sam Norman: Did you treat him?
Su Laurent: I didn’t. I am a firm believer that we should reserve antibiotics for very specific times when you know you’re treating a bacteria, which you need to be treated, which will get their on their own.
Sam Norman: Right.
Su Laurent: But for the vast majority of infections that babies will get and small children in the winter, leave them all alone, give them things to bring their temperature down, give them plenty of fluids, but don’t give them antibiotics.
Sam Norman: How do you make that decision, I mean you know, the anxious mother will automatically take her baby to a doctor and it really depends, doesn’t it , on the GPs instruction?
Su Laurent: I think it does, and I think that the more and more GPs are avoiding using antibiotics if possible, I mean you’ve probably had quite a lot of resistance around to antibiotics now.
Sam Norman: Yeah, yeah.
Su Laurent: And certain things we used to commonly use antibiotics for, you have to change your antibiotics because the original ones don’t work. I think on the whole, GPs are working on persuading parents that actually antibiotics are necessary except for a very few specific situations, I mean one of them for example will be pneumonia and another one will be meningitis, another one will be an urine infections, but as you can tell they’re all fairly major problems we’re talking about.
Sam Norman: Yeah.
Su Laurent: The average cold does not need them.
Sam Norman: But of course, everybody as soon as while I’m speaking from experience, but as soon as my children got ill when they were little, I automatically suspected that they had meningitis each time.
Su Laurent: Yeah, exactly, exactly. I think and every parent does to became with, but very soon you learn to pick up on, is much child actually just snotty and a bit miserable and off they feed slightly, but actually on the whole, okay, or are they really irritable, listless, lethargic, completely off feeds. There are two very different categories, and after a while you’ll learn to recognize the difference between those two. If you’re not sure, very important to see a doctor.
Sam Norman: Doctor anyway, yeah.
Su Laurent: And very often you’ll be able to be reassured but obviously sometimes medical attention will be needed.
Sam Norman: Because children can go from in one minute being absolutely fine come to the next minute, really poor and my temperatures and --
Su Laurent: And sometimes the first thing to do is try and get the temperature down.
Sam Norman: Yeah.
Su Laurent: You can do that by giving something such as paracetamol or Ibuprofen and then also by stripping your child off, keeping them cool, sponging them down. Really, the test about whether a child is really ill is, when you get that temperature down, did they seem completely back to their normal selves and happy and full of the joy as a spring, in which case don’t worry about them because the temperature itself will make a child irritable.
Sam Norman: Right.
Su Laurent: If on the other hand the temperature comes down and the child is still really windy and not himself, then do get someone to have a look at them.
Sam Norman: I have a very good tip about it and my boys may thank me for it. But when they were little and they got high temperatures, I could never get calpol down because they vomited back up again. So, I used to use these paracetamols, which were fantastic.
Su Laurent: Yes, they are. And you can get hold of those and they’re very good, they’re lot more expensive.
Sam Norman: They are massively expensive, but my goodness they were.
Su Laurent: They’re very good, they do work, if you can’t get your child to swallow something, I mean I used to syringe for my children when they were very small, I just squished it into their mouths, but yes, paracetamols or positrons for a child, you wouldn’t take something by mouth, fantastic.
Sam Norman: Yeah, so it is not damaging and you have this phycological effect.
Su Laurent: No, no, no.
Sam Norman: They did come with the point when they are absolutely fused and I was unable to administer the --
Su Laurent: Yeah, that point probably they all take them by mouth, I recognize that.
Sam Norman: Exactly.
Su Laurent: This time, take it by mouth.
Sam Norman: But it’s a good tip. Isn’t it?
Su Laurent: Yes.
Sam Norman: And there are some people, I think again it is sort of antibiotic and the GP, some people will be given antibiotics you know if and then some won’t.
Su Laurent: Yes.
Sam Norman: Presumably you just simply have to trust your doctor.
Su Laurent: I think you do, I mean there are some GPs nowadays who will say, your child has an ear infection; ear infections will get better without antibiotics. They will give a prescription to a parent, and they’ll say go away, give regular paracetamol, and wait for 24 hours. If in 24 hours, there’s no improvement, you may then want to go and get a prescription made up in your chemist.
Sam Norman: Yeah.
Su Laurent: And that’s often a quite a good thing to do because the parent who is absolutely adamant --
Sam Norman: For security, Yeah.
Su Laurent: They want an antibiotic, they’ve got security, they’ve got it now that prescription and they can go and get made if they want to, but you’ll be surprised how many children with ear infections within 24 hours is really the corner without antibiotics.
Sam Norman: They can see them a lot longer than 24 hours.
Su Laurent: When they are really screaming and they are really miserable. Sometimes something like a sort of a cold flannel against their ear can really help because the ear is very hot, so that can be very helpful and regular paracetamol, not just when it seems to be really bad, but give it every four hours and that’ll often really help as well, and between that you can give Ibbrufin, so really work on getting the temperature down, getting rid of the pain and often that will do the trick.
Sam Norman: Su, why do children get quite so sick?
Su Laurent: Well, I think children get lots of illnesses, lots of minor illnesses because their body is just getting used to be supposed to them and after a while they’ll gain some immunity against then. But interestingly enough children bounce back very quickly unlike adults, if you have a same illness in an adult such as chickenpox, they’ll often be very, very ill and for many days where the child with chickenpox can sometimes just shrug it off.
Sam Norman: Why is that? I mean how can it can be so extreme?
Su Laurent: Well, I think little are made to be therefore for children and adults, basic when it comes to adults. I mean the --
Sam Norman: Men.
Su Laurent: Men, men. I mean either, every man, you know when he has cold or caught a flu, he want to take --
Sam Norman: This exactly gives a man cold.
Su Laurent: Exactly.
Sam Norman: You were telling me something early about the chickenpox test and how – it’s quite a good tip, isn’t it?
Su Laurent: Well, I think it was a very interesting little experiment done by a couple of doctors on their child interestingly enough. What they -- the theory that they had was that, if the body was kept very hot, then you get more chickenpox spots, and if the body was kept cool, you would have fewer spots. What they did was, they took their child at the early stage of chickenpox and wrapped up half his body with lots of clothes, I mean half going vertically down his body, so one arm, and one leg with thick jumbos and thick clothes, and other side just had a little t-shirt and a pair of shorts. They sort of managed to kind of be very clever with how they design this and the side where he was very well wrapped and very hot, he had lots of spots, and on the other side, very few. They took a lovely photograph of that and put it in one of our British Medical Journals of Christmas.
Sam Norman: Poor little thing. So, you keep them cool?
Su Laurent: Keep them cool and don’t overwrap them.
Sam Norman: Now tell me about bronchiolitis because I mean that’s a really scourge at this time of the year.
Su Laurent: It is, it’s a real -- the baby illness, actually, babies and the elderly in fact. And bronchiolitis is a specific virus, which usually causes it and call them respiratory syncytial virus or RSV. I think it’s important for parents to be aware of its existence because it’s quite common and it can be quite a devastating illness. The way --
Sam Norman: But some people or some kids rather more prone to it than others?
Su Laurent: Well, probably, I mean it’s quite likely that -- first of all, age is a thing, so that it only affects the under one-years and the younger the baby, the more likely they are to get it and to be severely affected by it. What happens is a baby will get an illness, where they have a very distinct difficult, in fact I can diagnose over the phone, if my friends stay with me in the evening, they say, what is this cough? I can say that’s bronchiolitis. They also have a wheeze and they breath very fast and the combination of those three things means that they often go completely off their feeds, they just can’t feed and breath and wheeze and cough all at the same time.
Sam Norman: Right, yeah.
Su Laurent: And many children will actually be able to be managed at home. The GP will see the child and say, this is okay, we’ll keep an eye and manage at home. But there are a few children who’ll need to come to hospital. Those who need to come to hospital will very often need help with their feeds, they might need to have an nasogastric tube or even a drip, they will need to be on oxygen and they will often need to be in hospital for at least five days to a week.
Sam Norman: Wow.
Su Laurent: So it can be quite a devastating illness. And a very small minority may even have to go to intensive care to put on the ventilator, so it’s one way if you are worried about your child, he is wheezing and coughing and there always be the stress in not feeding, it’s very important to get medical attention.
Sam Norman: So it could be fatal.
Su Laurent: Potentially, every year one or two babies could die but the vast majority is very treatable, not with specific treatment, in other words, there is no drug that gets rid of the virus because it’s a virus.
Sam Norman: Yeah.
Su Laurent: But the treatment we give is supportive.
Sam Norman: Alright, okay. So it’s an important to get help if you suspect bronchiolitis in your child?
Su Laurent: it is, yes.
Sam Norman: It’s a very distinctive?
Su Laurent: It’s a very distinctive illness that it happens in the autumn and the winter.
Sam Norman: Right.
Su Laurent: So you know our peak time is probably November, it’ll start in October, and it’ll get more and more in November, December and they petering out by about March.
Sam Norman: Do you get plagued over time with friends ringing up, my kids got.
Su Laurent: I do, I do. Actually, I see it as a pleasure and something that I can do and often it’s just a quick question that something that I can help with, so it’s not a big deal actually.
Sam Norman: Because if I am you, I’ll be ruthless, I’ll be on the phone all the time.
Su Laurent: Everyone have family and got children.
Sam Norman: So give me your number. What stage, I mean I have an asthmatic son, he is never had bronchiolitis, but at what stage do you diagnose or can asthma be diagnosed in your kid?
Su Laurent: Well, I have an asthmatic son as well.
Sam Norman: Really? Su, your eldest?
Su Laurent: He is my youngest.
Sam Norman: oh he is the youngest.
Su Laurent: Yeah, interestingly enough.
Sam Norman: My fairy guess.
Su Laurent: Yeah, when there actually is a correct theory because it’s often – it’s common only in the elder children, yeah. Anyway, but you know he is the youngest, and usually we don’t make a diagnosis, especially till they are about 18 months. So, you may have babies who wheeze quite a lot when they get viruses, but they will just tend to be wheezes with viruses and then they’ll tend to outgrow it by the age of about 18 months. But there are those who carry on wheezing with viruses that we then start to say this is probably asthma.
Sam Norman: Alright, okay.
Su Laurent: There is no blood test or X-ray which is going to diagnose asthma. It is simply the way in which they respond to treatment, which makes a diagnosis. So, you give them the inhaled medication.
Sam Norman: Yeah.
Su Laurent: The wheeze goes away, they’re over 18 months and you say, this is very likely to be asthma.
Sam Norman: Alright, and it’s always -- my son seems only effected if he has got a really bad cold or?
Su Laurent: Yes, yes, that’s the commonest thing taken in small children.
Sam Norman: Alright. They may or may not grow out of it.
Su Laurent: Yes, I mean, what happens with asthma is that you have the gene, you’re born with that gene and that gene is the same one for asthma, for hay fever and for exma allergies, it’s the tents same group and it tends to – if you look in families, you’ll tend to see there are other members who have either hay fever or asthma. But very often, children will suffer far worst from it than elder, than teenagers or adults, and many of them will gradually get better and not need inhalers. But I will always say to parents, you should never think the child is completely outgrown it and when they’re older, they may come across something for example, cigarette smoke that triggers it off again.
Sam Norman: Yeah.
Su Laurent: And I always say it’s vital that children with asthma do not smoke when they are adults, it’s vital they are not exposed to cigarette smoke at all.
Sam Norman: You should always -- what’s the brown in this, it’s a huge monster.
Su Laurent: The brown one inhales steroid.
Sam Norman: Right.
Su Laurent: It’s very clever -- the companies, all the companies have color coated their inhalers, so you know what sort of drug they are. This inhale steroid is not a preventer and the blue one is the one that you give in acute situations for treatment.
Sam Norman: So, you should always give the brown inhaler?
Su Laurent: If your doctor has prescribed a preventer, in other words, if your child needs very regular inhalers because your child is getting regularly wheezing or coughing, then your child may well need a brown one as well. If you’re prescribed the brown, you have to give it everyday.
Sam Norman: Right, okay. Because Harry for instance, I don’t want attend to his personal session, but Harry gets asthma may get asthma, maybe once a year.
Su Laurent: Yes, in which case he doesn’t need a brown one, he’ll just need the blue one for when he gets it, but the rest of year he needs nothing.
Sam Norman: Okay, that’s great, thank you very much. What is a croup, thank god I never had to deal with that but.
Su Laurent: Croup is a very distinctive thing and in fact most parents will know what croup is, it’s a little thing that’s been around for a very long time and grand parents will often say, well, that’s croup. It is a narrowing of the upper airways, it’s not the lungs that are affected this time.
Sam Norman: Yeah.
Su Laurent: it’s the upper airways and the posh term for it is Laryngotracheobronchitis, so it’s from the larynx, down the tracheo, into the large airways in the lungs, but not the lung substance itself. What happens is, when the child breathes in, they make a very loud noise, like that.
Sam Norman: Yeah.
Su Laurent: And they also have a bark, which sounds like a sea lion, it’s a very -- it’s another that you can do over the phone.
Sam Norman: Alright.
Su Laurent: Those children with croup, the sort of -- the way of – the traditional way of treating is to go into a humid atmosphere, so it’s the sort of boiling kettle thing, we are going into the bathroom, running in hot taps and inhaling steam.
Sam Norman: Right.
Su Laurent: And that’s the sort of -- that’s the home remedy for it, making sure of course, that you don’t, but boiling water anyway near the child. But in fact, there are other ways for treating it now and your GP or casualty or the pediatric department of the hospital may well prescribed some steroids, either to take by mouth or to inhale and it will often have a very rapid effect on the lungs. A very good example is when my eldest one developed a croup. In the middle of the night, one night he came down, barely able to breath like that, it was quite scary and I am being a pediatrician, I immediately dialed 999, but I had some steroids, which we were giving out path at that time and it’s a same stuff, so I just put a whole lot into Alex.
Sam Norman: She may, but he ask would dad too fat --
Su Laurent: And to be a Paedriatrician. Within 20 minutes he was back to normal.
Sam Norman: Thank you Su, that was excellent.
Su Laurent: It’s my pleasure.
Sam Norman: Thank you.
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