What are Health Visitors

Su Coleman: I am Su Coleman and I am a Health Visitor for Ealing PCT. A health visitor basically used to be very much about child surveillance, but in the recent years, it's become much more to health promotion really. So it is not only health promotion now, but it is also supporting families, empowering them to take control with their own values, with informed choices etcetera. We do some child surveillance still. I'm running the baby clinic, certain development checks, immunizations. Well, the sort of day that we can deal with, might be a baby clinic in the morning, maybe baby massage, maybe running a sleep group, which is very popular because we do find that's one of the major reasons that people come to the clinic. And then we might do approx three or four visits in the afternoon, perhaps to new babies, maybe to follow up some problem, maybe to visit one of the families. So it can be quite varied and of course, a lot of meetings in between. We are actually just started the mornings baby clinic so the mums will come along with their babies, from zero to five, but we don't see many five-year-old. And as they are weighed, they are asked if they want to see a health visitor. And if they do then they come along to me and I see them and sort out any problems they might have and have a chat. It used to be more chaotic than this, because we used to just sat, and the mums just coming in when they came. So it sometimes becomes 20 or 30 in here at one time. But now we don't call two at a time. So it's less chaotic. And yes, we have these toddlers or babies involved as chaotic but we don't know what we do. I hear you don't like getting undressed young lady. Female Speaker: No, but she has lost pretty -- Su Coleman: Yeah, she does. That will have much as you like. Alright, so let's see. So she is a term baby? Female Speaker: She was 38 weeks. Su Coleman: Alright, so they so plotter it, don't they? So six weeks she is doing nicely going along with 25th. You are breastfeeding or --? Female Speaker: No, bottle. Su Coleman: Which one do you use? Female Speaker: And we start from SMA Gold, but she got quite a bit constipated. So we changed to -- Su Coleman: Aptamil? Female Speaker: No. Su Coleman: Cow & Gate. Female Speaker: Yes, Cow & Gate. Su Coleman: And that suits her. Female Speaker: It does, but she has a little bit of diarrhea during the last couple of days. She just had enough. Su Coleman: Alright, when you say diarrhea, what's in that; watery or --? Female Speaker: Well, it's a mixture. Sometimes it can be quite runny and then it can be a bit harder again. Su Coleman: And what color? Female Speaker: Yellowy. Su Coleman: Diarrhea is how frequently they go, not the consistency. So she is going more frequently three times more frequently than the normal, then that's comes to diarrhea. So if the stool is going as normal but it's runnier that's opposite of diarrhea. Female Speaker: Right. Female Speaker: She is 7.57 kilos. You can take her up above. Su Coleman: Alright let's just talk about the centiles, which we plot all babies out when they have their weight and length. And what we are doing is we are looking at every 100 males or females at that point of time in the book. And so the average I would see would be the 50th centile which is at that point of time; 50, let's say, boys are lighter and 50 boys are heavier. So this gives us a good guide as to what their weight is doing. We don't mind them going up the centiles, we don't mind them dropping down the centiles, but there is a point where we say actually this baby is overweight, or actually this baby is losing too much on the centile. And yes, at the beginning, the mothers know nothing about centiles at all, but they soon learn. So first thing they ask where the -- Alright so weight, so he is just over two weeks now and he is doing very well about the 50th centile, so that's excellent. So do you have any queries? He has got a bit of cradle cap around his eyes, isn't it? Female Speaker: Yes, on his head. Su Coleman: And on his hair. Probably -- have you washed them today or not? Female Speaker: No. Su Coleman: When you wash him, how much of it comes off? Female Speaker: Some of it is quite sticky, but most of it comes off. Su Coleman: It does that's fine. It not, take some olive oil a little dab on your finger and massage it well into it, okay and if you do that a couple of days then it should come off. His eyes aren't red, are they? No, that's fine. So I think the left one is a blocked tear duct, and the right one is just a little bit of cradle cap is got down there. A baby came here a, because he is first weighed after birth and secondly, because he has got some cradle cap. That cradle cap is not always on the head, it sometimes can go lower and this one is actually just in his eyebrow, and the other eye has got a sticky eye. And we can treat sticky eyes with breast milk; it's very good to clear it and the cradle cap with some olive oil and that's a very common thing that mums come with us. We asked the mums to bring the babies in during the first two or three weeks so we can get a base weight to see how well they are doing. The mid wife will weigh them on discharge which might be after ten days. So then we say come within the next couple of weeks and we'll weigh them and then we'll go from there. Alright, so your baby has the BCG? How is the arm? Female Speaker: He is good. Su Coleman: He did it good, and has he come up into a little lump at all or not? No, fine. Alright, so weight wise 12 weeks, very good 50th centile, that's excellent come from there, very good. Are you breastfeeding? Female Speaker: Yeah. Su Coleman: Well done. Male Speaker: It's mixed milk. Su Coleman: With a bit of bottle as well. Okay, do you have any concerns about anything? Female Speaker: Just he has got, I think it's a cradle cap. Su Coleman: Yes, this is a cradle cap. Have you been putting anything on there? Female Speaker: No. Su Coleman: What you need to do is every evening rub some olive oil in, rub it in really well and then wash it off the next morning. It will probably take three to four days to clear. Okay then that's fine, and as for coming back, I'll leave it to you, he is doing very well. So maybe three to four weeks time, but if you want to come soon, you are welcome. Alright, nice to see you! Female Speaker: Thank you. Su Coleman: I will just tell you a little bit about the red book, which is a universal book, although each parent has got something slightly different in them. And every baby that is born is issued with the red book, mostly by the hospitals nowadays, the maternity hospitals. But if not, then the health visitors would give them out. This is a comprehensive guide right the way through their childhood of all the immunizations, clinic attendances, GP, hospital, anything meant to go really goes into this book. So it's a very useful guide for both the mum and the child to have this handy. And the mother can write in it as well. We tell them it's your book, you write in it as you want to. So they really value them and look after it. I just finished the baby clinic this morning and that's taken up most of the morning, and then this afternoon after we had lunch, we are going to, I am going to Ealing and visit the people at home that need home visits. Yes, the first family we are going to see this afternoon is a family that's a little bit chaotic, disorganized, but doing extremely well, with a lot of support from various agencies and I am very pleased with them, and so they made a huge difference. So we do as well, so we are going along to see them. See how the children are doing. One has just started nursery school, so we are seeing how he is coping with that. And just seeing how mum and dad all made it, how they are coping with everything. Hi! Female Speaker: Hi! Su how are you. Su Coleman: Very well! You? Female Speaker: I am very good. Su Coleman: Thank you very much. Children are quiet? Female Speaker: Oh yeah, they are in the front room. Su Coleman: Watching any video or something? Female Speaker: No, they are just sitting waiting for you. Su Coleman: You can sit him up if you like, maybe you find that easier. There is a good chap. Well done! Look at him. That's alright, that's alright. 7.74 okay, you can lift him up now. 7.74, I am going to ask you to put him down again and put him down straight sitting, because according to this, he has actually lost. Male Speaker: As he is not more eating only it's -- Female Speaker: Oh God! He eats a lot now. We have found a new thing that he likes. If he doesn't eat any food, he eats the fruit cocktail or something to do with fruits. Su Coleman: With fruits. Female Speaker: Yeah, he eats any fruits, or he likes a cup of soup. Male Speaker: Or porridge. Su Coleman: Okay, you can pick him up. Well, what I think we want to do with this little chappie is, to bring him along to the clinic if you can in a month's time, bring him on the Monday morning. The day before you bring him, I want a whole day of what he is eaten that day, from midnight to midnight. So I am not calling the day starting when he wakes up at 10, 24 hours absolutely right, because his weight is down below the centile now. So we need to see him in a fortnight and to see if he is gaining weight alright. So we've just visited the first family of the afternoon, and really it's just a case of going to see how they are doing, how everything is jelling together, if they are attending all the courses they are suppose to be attending, which they appear to be doing. And they do work really hard towards maintaining what we hope they can maintain, and what they can achieve and they really are working hard towards it. And with our input hopefully we will get them there. So the next visit of the afternoon, we are going to see a baby of about 8-9 months to do something called a Guthrie Test and all babies born in this country, or babies coming to this country under a year, this test is carried out on them, because it's a reliable cheap and easy way to check for several conditions. Oh hello! How are you? Female Speaker: Nice to see you. Su Coleman: Let me take my shoes off. Female Speaker: Okay sure. Su Coleman: Is this little one awake? Female Speaker: Just, she was sleeping so. Su Coleman: Oh! Bless. Did you put some socks on her? Female Speaker: Two pairs. Su Coleman: Good girl, okay. Female Speaker: Okay, thank you. Su Coleman: And the sort of reaction we might get when we do is it she'll cry it's painful, and she don't like it very much, but other than that, I am not going to -- what we are going to do is take some blood from her. That's all we are going to do, not pleasant for the young lady. I am sorry my child, but actually I hate doing this. If you don't do a good trick to begin with, you end up doing three or four. So it much better to do just a good -- Oh my darling, not fair and you've just been to sleep. So we will see you at the clinic sometime. If you have got any concerns, ring us; if not, just pitch up at the clinic. Female Speaker: Alright, so I expect to get - Su Coleman: Definitely, if you run them, it will be no problem. Don't worry about that. Okay, bye, bye. Female Speaker: Bye, bye! Su Coleman: It was a nice visit, but I was a bit sad having to tuck the baby from both ends, but the blood came out very nicely so that was good. Mum had done what I had asked her to do, which is put the socks on the feet to and they were really nice and warm. So that makes it much easier. Okay, our last visit of the day. We are just going to see preterm twins, twin girls. I think they are -- but we will find that when we get there. Mum has done exceedingly well. She is breastfeeding them both, and they are both doing very nicely. And we just weigh them for a spell at homes, so that they don't have to be exposed to the clinic setting, and infection, but I think probably today, if they have done as well as they have done, will be the last home visit, and then I think from now on, she'll probably come up to the clinic with them. So we are just on our way there. Hello! Nice to see you. Female Speaker: Me too. Su Coleman: Let me take my shoes off. How many week preterm there again? Female Speaker: They were born at 29 plus four so that's ten and half weeks. Su Coleman: Ten-and-a-half weeks, super. Here we go. 3.88 so she is five six and a 380. Female Speaker: That's okay, isn't that? Well done, well done. Oh there you go. She like it there, oh goodness! Look at you. Su Coleman: She is more I would say. Yeah she is more. Very good! Female Speaker: You are huge. Su Coleman: Have you got a smile? Female Speaker: Go on, go on. Su Coleman: Nice to see you, bye. Okay, so the final visit of the day was to preterm twins. I think they were ten-and-a-half weeks preterm, they are now about 18-19 weeks of age. They are doing very, very well. Mums are brilliantly breastfeeding them both, and their weight gain is so good that they can now start coming to the clinic. I asked them when she wants to come and they are doing very well. So yes, I think every visit I achieve what I wanted to achieve, and now I was very pleased with all, but I am now back to the office at half past four and I have got at least two hours work, writing up the records, making sure the computer forms are filled in, sending the blood samples out. So it'll been another two hour before I'd say that my day is actually finished.