Let's start at the beginning

The first few years of a baby’s life can be fraught with health concerns, and it’s often difficult for parents to work out what’s normal for their child and what needs further investigation, but pharmacy staff can be on hand to help

Unfortunately, babies don’t come with an instruction manual. For parents, this means that taking their little ones home from the safety of the hospital for the first time can be daunting to say the least. But pharmacy teams can be on hand with a whole host of information, advice and reassurance that can help parents know what to expect and how to deal with the unexpected. You could say it’s as easy as ABC…


Allergy

Cows’ milk protein allergy is the most common allergy in babies, often causing an immediate reaction and symptoms such as irritation and swelling of the eyes, skin, mouth and tongue, sneezing and a bocked nose, abdominal pain, diarrhoea and vomiting. Delayed reactions can also occur, often with gastrointestinal or skin-related symptoms (e.g. eczema). Babies with suspected cows’ milk allergy should be referred to the pharmacist as they may need to see a GP for a diagnosis.

Bowel trouble

When they’re constipated, babies will pass infrequent, dry, hard stools that may be accompanied by straining and pain. It’s important to check that infant formula milk is being made up correctly, as too much powder will make the feed more concentrated and might lead to constipation. Older babies should eat plenty of fibre, such as fruit, and drink plenty of water to avoid constipation. 

Loose or watery stools are classed as diarrhoea. Associated symptoms include stomach cramps, nausea and vomiting, headache, loss of appetite and dehydration. If babies don’t want to eat, drinks should still be offered regularly to prevent dehydration. An over-the-counter oral rehydration solution may also be suitable. If a baby has diarrhoea, it is important that everyone in the family washes their hands regularly with soap and warm water to avoid spreading any infection.

Chickenpox

Chickenpox causes a red, itchy, spotty rash that develops on the face or chest before spreading to other parts of the body. Over the next few hours or the following day, very itchy fluid-filled blisters develop on top of the spots, and after a further few days, these dry out and scab over to form a crust. Chickenpox is contagious until all the blisters have scabbed over. Paracetamol can be taken to relieve fever and discomfort, while moisturising creams or cooling gels can help to ease itching.

Digestive distress

To be diagnosed with colic, an infant must display all of the following symptoms from birth to four months of age: 

  • Bouts of irritability, fussing or crying that start and stop without obvious cause 
  • Episodes of the above lasting three or more hours a day and occurring at least three days a week for at least one week 
  • No failure to thrive. 


When it comes to managing colic, practical approaches such as correct positioning during feeding and frequent winding can be effective. Special formula milks, anti-colic teats or OTC medicines such as dimeticone, simeticone or lactase drops may be beneficial.

Babies may also experience reflux, which is when the contents of the stomach come back up into the oesophagus. Winding the baby during a feed, holding them upright after feeding or giving smaller feeds more often can help prevent it. Healthcare professionals may also recommend thickened feeds.

Parents who suspect their baby may have colic or reflux should be referred to the pharmacist. 

Eczema

Atopic eczema, the most common form of the condition, often starts between the ages of two and four months. It causes the skin to become itchy, red, dry and cracked, most commonly on the cheeks, forehead, scalp, behind the ears or in the creases of the neck, knees and elbows. Eczema can ‘flare up’ so that symptoms worsen and the skin may become infected. 

There is no cure for eczema, but it often improves as children get older. Parents can be advised to bathe their infant using an emollient wash and to apply an emollient cream generously and frequently, including after bathing. A topical corticosteroid may be prescribed for use during flare-ups, alongside emollients, to reduce redness and swelling.

Feeding

The Department of Health recommends exclusive breastfeeding for the first six months of a baby’s life as this provides the correct balance of nutrients required for optimal growth and development. Some mums cannot – or choose not to – breastfeed and infant formula milk is the only accepted breast milk substitute. Infant formula milk is based on cows’ milk, but is modified to make it as close to breast milk as possible so parents can be reassured that whatever option they choose for their baby, they will still get all the nutrients they need. If parents would like more advice about feeding their baby, refer them to the pharmacist.

Group B streptococcus 

Group B streptococcus (strep) infection is the most common cause of life-threatening infection in newborn babies and the leading cause of meningitis in babies under three months. Symptoms usually develop within the first few hours or days of birth, and include being floppy and unresponsive, poor feeding, grunting when breathing, irritability, an unusually high or low temperature, unusually fast or slow breathing and an unusually fast or slow heart rate. Parents should seek immediate medical advice if they think their baby may have a group B strep infection so that antibiotics can be prescribed.

High temperature

A fever is when a child has a temperature of over 37.5°C. They may also have flushed cheeks and feel clammy. Rather than being an illness, a fever is often a sign that an infection is present and it’s thought that fever helps the body to fight bacteria and viruses. Therefore, it should be left to run its course, unless it’s distressing the child, in which case they should be given a paracetamol or ibuprofen suspension. Paracetamol is suitable from two months and ibuprofen for babies from three months who weigh 5kg or more.

Infections

Children tend to pick up between three and eight colds a year and symptoms include a cough, sneezing, runny nose, sore throat, headache and earache. To ease symptoms of this common infection, children should drink plenty of fluids and get lots of rest. If a child under six years has a cough, a simple cough mixture containing ingredients such as honey and lemon or glycerol may be suitable. For babies, saline drops or spray can help make breathing easier.

Jabs

A range of vaccinations are routinely given on the NHS to children between the ages of eight weeks and seven years to help protect them against a range of serious and potentially fatal diseases. Public Health England encourages pharmacy professionals to advise parents to administer paracetamol to babies after receiving the meningococcal B (MenB) vaccine, as the vaccine may cause a fever.

Keeping active

It’s important for infants of all ages to be active. Before babies begin to crawl, parents should encourage them to be physically active through reaching and grasping, pulling and pushing, and moving their head, body, arms and legs during daily routines and supervised play on the floor. Children who can walk on their own should be physically active every day for at least 180 minutes (three hours), spread throughout the day.

Lactose intolerance

Lactose intolerance can occur in babies when there is a lack of lactase, an enzyme needed for the body to digest lactose. Symptoms include a bloated stomach, abdominal pain, wind, loose stools or diarrhoea, mild colic, poor weight gain or even weight loss. A lactose-free formula milk could be used, or lactase drops can be used to break up some of the lactose in regular formula milk, making it easier to digest. Refer parents who suspect their baby has a lactose intolerance to the pharmacist.

Meningitis

Symptoms of meningitis develop suddenly and can include a high temperature over 37.5°C, being sick, a headache, a blotchy rash that doesn’t fade when a glass is rolled over it (this won’t always develop), a stiff neck, a dislike of bright lights, drowsiness or unresponsiveness and seizures (fits). Parents should be advised to trust their instincts and not wait until a rash develops. They should call 999 or go immediately to A&E if meningitis is suspected. If not treated quickly, the condition can cause life-threatening blood poisoning and result in permanent damage to the brain or nerves. Around one in 10 cases are fatal.

Nappy rash

Most cases of nappy rash are caused by a reaction of the skin to urine and poo. The skin will be red, look sore and feel hot to touch. There may also be spots, pimples or blisters. Advise parents to change the nappy often and wash and dry the skin properly. Barrier creams may help to protect the skin from moisture and irritation. A thin layer should be applied just before putting on each nappy.

Otitis media with effusion

Glue ear, or otitis media with effusion, is a common infection where the middle ear becomes filled with fluid, causing hearing loss. Most cases don’t require treatment and the condition will improve by itself, usually within three months. If symptoms persist or speech and language is affected, glue ear may be treated with minor surgery, which involves inserting grommets (small tubes) into the ear to drain the fluid.

Pneumonia

Pneumonia can develop suddenly or more slowly over several days, and a cough is often one of the first signs. Symptoms include a bad cough, coughing up mucus, difficulty breathing, rapid heartbeat and loss of appetite. To help prevent pneumonia, encourage parents to take their babies for all of their vaccinations, especially the pneumococcal vaccine, as well as the jabs for hib, diphtheria, and whooping cough.

Quiet life

All babies cry as a way of showing that they need comfort and care. The most common reasons for crying are hunger, a dirty or wet nappy, tiredness, wind, being too hot or too cold, boredom, overstimulation, or simply wanting a cuddle. If the baby is not hungry, parents can try stroking the baby’s back or holding or rocking the baby to comfort it. A warm bath or finding something for them to listen to or look at, such as the radio or a rattle, can also help. 

Respiratory problems

Wheezing can be quite common in children under the age of three as their airways are small. It’s usually nothing to worry about, especially if the child has a throat infection or a cold. If wheezing is accompanied by a persistent, dry cough that is worse late at night or early in the morning, and shortness of breath and tightness in the chest, it could be a sign of asthma. It can be difficult to know whether or not a baby has asthma so a GP may prescribe asthma medication for a short time to see if symptoms improve.

Seborrhoeic dermatitis

Commonly known in babies as cradle cap, seborrhoeic dermatitis is characterised by large, greasy, yellow or brown scales on the baby’s scalp. Most cases don’t cause discomfort and will clear up on their own, but gently washing the hair and scalp with baby shampoo can help prevent a build-up of scales. Massaging baby oil into the scalp at night can help loosen the crusty scales.

Teething

On average, babies cut their first tooth at about six or seven months of age. When teething, babies may become grizzly, irritable and clingy and common signs include dribbling, red or flushed cheeks and red, swollen gums. A painkiller such as paracetamol suspension or ibuprofen suspension can be given to help ease pain and discomfort. Teething gels containing a local anaesthetic such as lidocaine can help numb painful gums. Teething rings can also be helpful.

UV protection

Babies and children need to have their skin protected from the sun’s potentially harmful rays. Babies under the age of six months should be kept out of direct sunlight altogether, especially around midday. Even in the UK, exposed areas of children’s skin should be covered with sunscreen that’s formulated for children, has an SPF of 15 or more and protects against both UVA and UVB rays. It should be applied to shoulders, nose, ears, cheeks, and the tops of the feet and reapplied frequently throughout the day, even if it’s cloudy or overcast. A hat and sunglasses should also be worn.

Vitamins

Department of Health advice states that all children aged six months to five years should be given vitamin supplements containing vitamins A, C and D every day. If a baby is being breastfed, they should be given a daily vitamin D supplement from birth. Babies having more than 500ml (about a pint) of infant formula a day won’t need vitamin supplements because formula milk is fortified with vitamin D. Vitamin drops are available as part of the Healthy Start scheme.

Weaning

Weaning – the process of learning to eat solid food – should begin no earlier than 17 weeks and no later than 26 weeks of age. Signs that a baby is ready to wean include being able to sit and hold their head steady; co-ordinating their eyes, hands and mouth, and being able to swallow food without pushing it back out with their tongue. Mashed or puréed cooked vegetables and baby rice made up with breast or formula milk are suitable first foods, followed by mashed fruit. Full-fat dairy products such as yoghurt can then be introduced, as can blended or puréed cooked meat, fish or pulses.

X marks the spot

To allow them to pass through the narrow birth canal, babies have two fontanelles – or soft spots – on the top and back of their heads. Eventually, the bones will meet and fuse, and the soft spots will close. Until then, parents should be advised to keep an eye on their baby’s fontanelles as they can give important clues to the state of their health. If they’re sunken, it may be a sign of dehydration, whereas bulging fontanelles can be a symptom of serious illness, such as meningitis. 

Yellow skin

Jaundice is a common and usually harmless condition in newborns that causes yellowing of the skin and the whites of the eyes. It is caused by a build-up of bilirubin – a yellow substance produced when red blood cells are broken down – in the blood, which can’t be processed by babies’ under-developed livers. Jaundice often corrects itself by two weeks of age without causing any harm, but should nevertheless be checked by a GP to see if treatment is needed. 

Zzzzz

Babies will have their own pattern of waking and sleeping, and some will need much more sleep than others – anything from eight to 18 hours a day. Babies should be taught the difference between day and night from birth so that they begin to associate night-time with sleeping. Babies should be in the same room as their parents when sleeping, both day and night. Recommend that parents introduce a bedtime routine when their baby is around three months old. This could include having a bath, changing into night clothes and a fresh nappy, brushing their teeth (if they have any), and listening to a lullaby before dimming the lights.

The Department of Health recommends exclusive breastfeeding for the first six months of a baby’s life

Originally Published by Training Matters

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