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Learning and development

When children return to school after a long summer break, parents often concentrate on buying new school uniform, children’s shoes and stationery supplies, to make sure their child is well-prepared for the year ahead. But many don’t think about ‘back‑to-school’ health in advance

Community pharmacies are well-placed to offer advice and suitable children’s healthcare products for everything from managing a fever and treating colds and flu to eradicating head lice and other infestations.

The launch of a nationally funded Pharmacy First style service in England this year should hopefully drive more parents to the pharmacy for advice and products for common children’s health problems.

“When children go back to school, many will pick up minor conditions, which can often be treated in a community pharmacy,” says Kenny Chan, Numark lead information pharmacist. “From coughs and colds to head lice and warts, pharmacies can help to treat and manage these minor health concerns. Pharmacies can set up health promotion zones in the pharmacy itself, but these zones could also be set up in local libraries and community centres. Pharmacies can contact local schools, who are often able to send out messages to parents to use their local pharmacies for advice and information.”

Coughs and colds

Pharmacies should be the first port of call for children’s coughs and colds, unless there are any red flag symptoms. However, according to research conducted in March 2022 at Aston University in Birmingham, more work is needed to raise awareness of the role community pharmacies can play in children’s health, as the GP is usually the preferred healthcare provider for minor ailments in children.

Chan says community pharmacists can initially work with parents to find the most appropriate treatment, and then advise if a GP appointment is necessary or if a prescription for antibiotics, for example, is needed. “Coughs and colds can be remedied with products such as cough mixtures, nasal sprays and lozenges,” he says. “Additional products that pharmacies could stock are tissues and antibacterial hand gels, so parents can help their children prevent the spread of germs. Paracetamol and ibuprofen will help with fever and general pain associated with colds and flu, while various cough mixtures and lozenges are available to soothe the symptoms of a cough and a sore throat.”

Children may have eight or more colds a year, but winter viruses like colds and flu tend to be more prevalent between October and March. “Coughs and colds are constantly circulating, and children often get more of these when they go back to school,” says Alwyn Fortune, policy and engagement lead – Wales at the Royal Pharmaceutical Society. “All children from six months to five years are advised to have a daily vitamins A, C and D supplement. Parents don’t necessarily need to buy the most expensive vitamin brand on the shelf, and pharmacists can show them how to find a vitamin to suit their child’s age and needs, and their budget.”

In July this year, the Government confirmed that children in school years seven to 11 will be offered free flu vaccines from September for the 2023/24 season. 

Consent letters will be sent out to parents and guardians before the school clinics, with information on the vaccinations. For children not attending school, such as those who are home schooled, parents can book a flu vaccine at a local community clinic. 

The lowest rate in a decade

The UK Health Security Agency is concerned about a steady rise in measles outbreaks this year and the potential for a measles resurgence, especially in London. 

Between 1 January and 30 June, there were 128 cases of measles, compared to 54 cases in the whole of 2022, with 66 per cent of the cases detected in London (although cases have been seen in all regions). Outside of London, the risk of large measles outbreaks is low, but smaller outbreaks are occurring in certain populations, including teenagers, young people (aged 19 to 25) and under-vaccinated communities.

Parents whose children missed out on routine MMR vaccinations, or anyone of any age who hasn’t been vaccinated, are urged to have a vaccination. Current MMR vaccine coverage in the NHS routine childhood programme is the lowest it has been in a decade.

Common parasites

Head lice are most common in children aged three to 11 years, although they can affect anyone, including adults. They are easily spread through close head-to-head contact and tend to be more common at primary school because of the way young children play and learn. While a head lice infestation is often a minor inconvenience, if left untreated, it can lead to complications, such as an itchy rash at the back of the neck and behind the ears, loss of sleep and skin infections (caused by excessive scratching). 

Research carried out in February at the Medical Entomology Centre, Insect Research & Development Limited, Cambridge, found that within any school community, some children are regularly infested because their parents/guardians don’t treat the infestation, or they try but are unsuccessful and don’t seek help. 

According to the UK Health Security Agency’s advice to schools on managing specific infectious diseases (updated in February), sending letters and notifications to parents or carers doesn’t reduce the risk of transmission and may provoke anxiety. 

Instead, it says schools should “encourage parents and carers to give regular head checks and provide good hair care to help identify and treat head lice early”. Raising local awareness of head lice detection and treatment through pharmacies may be an effective way of keeping infestations under control.

“Some pharmacies have promotional digital display screens, which are a great asset for marketing head lice products, along with display banners and aisle fins that can be used within the store,” says Lucy Willars from the Hedrin head lice brand.

The NHS website recommends wet combing to remove head lice and nits. According to Community Hygiene Concern (CHC), the success of wet combing depends on the choice of the comb and method being used. 

CHC’s ‘Bug Busting’ kit involves using a specially designed comb with normal shampoo and conditioner. The NHS website says it usually takes about 10 minutes to comb short hair, and 20 to 30 minutes for long, frizzy or curly hair. Lubricating the hair with a conditioner or a medicated product containing dimeticone makes the procedure easier, particularly for curly hair. 

If wet combing fails to work, parents should then use medicated treatments. 

Current NICE guidance recommends that a physical insecticide, such as dimeticone, should be the first-line treatment before using a chemical pesticide. However, wet combing or using products containing dimeticone are the recommended first-line treatments for pregnant or breastfeeding women, young children aged between six months and two years and people with asthma or eczema.

“It’s imperative for pharmacies to have head lice treatments available in different forms, such as rinses, mousse, liquids, shampoos and sprays, in addition to head lice combs,” says Chan.

Threadworms are another common childhood infestation, especially in children under 10 years. These tiny worms are found in stools and look like small pieces of thread. They usually come out at night and spread easily from person to person. Threadworms don’t always cause symptoms, but can cause itching of the anus or vagina, which may disturb sleep. The infestations can usually be treated with a single dose of mebendazole from a pharmacy. 

“If parents feel embarrassed about discussing certain health issues, such as head lice or threadworms, they can go into the private consultation room,” says Fortune. “Using leaflets, promotional materials and posters in the pharmacy can help to raise awareness of these common conditions. Some medicines can be costly, so it’s helpful for pharmacies to find out which conditions are covered by any local NHS ailments schemes.”

“It’s imperative for pharmacies to have head lice treatments available in different forms, such as rinses, mousse, liquids, shampoos and sprays, in addition to head lice combs”

General health advice

According to research by Oxford Brookes University, the University of Birmingham and the Oxford Health NHS Foundation Trust, the number of school nurses has fallen by 35 per cent in the last five years to about 2,000. 

As well as managing minor ailments and injuries, school nurses often deal with public health issues, such as immunisation, sexual health, managing chronic conditions and mental health support.

The Asthma + Lung UK charity says that every year, there’s a spike in asthma attacks in children across the UK when they return to school after the summer. 

This may partly be due to the rise in colds and other respiratory infections, but it may also be due to allergies or stress and excitement. “Community pharmacists are ideally placed to deal with all types of medication enquiries,” says Fortune.

“Children with asthma often develop worse coughs and colds. When they go back to school, it’s important to make sure that they and their parents can use their inhalers properly, and that they have been prescribed preventer inhalers.”

Chan adds that sleep should be a priority for children going back to school, and this is something that pharmacists may be able to advise on. 

“Holidays usually mean later bedtimes, so getting children back to a regular routine is beneficial,” he says. “Restricting the use of phones, TVs, tablets or computers one hour prior to bedtime will also help, alongside warm milky drinks.”

Views from the p3pharmacy panel

“Back to school healthcare has always been a seasonal category for our pharmacy. The main areas we usually deal with include head lice, threadworms, ringworm and chickenpox. Often, parents want confirmation about their child’s symptoms as rashes may need differential diagnosis. Our best selling ranges include Ovex for threadworms, Canesten for ringworm, Full Marks for head lice, Piriton and Cicastela cream for chickenpox. Be aware of link sales you can make, especially for chickenpox (e.g. analgesics, antihistamines and anti-itch creams.)”

“This continues to be an important sector for our pharmacy. We are seeing more cases of chickenpox and head lice. Common questions are about impetigo, skin rashes, strep A and high temperature. A lot of the stuff we get asked about is a community service and doesn’t lead to sales as it might be things parents already have at home, such as Calpol for bringing down a temperature. More parents are coming to see us than ever because they can’t get a GP appointment. Have things on display as much as possible and keep P medicines at eye level.”

“This is a fairly important area for us, particularly for chickenpox and head lice. We’ll get asked about which are the best types of treatment for headlice, the difference in types of ingredients and how they work, and how often you need to use the treatment. Chickenpox is a big area for us, and we get a lot of requests at back to school time. Lots of parents need advice on treating chickenpox and often they don’t know the best type of pain relief to give or what to use to relieve itching. For chickenpox, Piriton liquid, Calpol and ViraSoothe do well for us. For headlice, our best seller is Lyclear.”

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