Picking up more than an education

PARENTING:Now that the school year is back in full swing, those embarrassing childhood infections are ready to to rear their ugly heads once again

IT IS three weeks into the new school year, so any day now a note will arrive home in the bag announcing that a child in the class has been infected with head lice and parents should check their children’s hair.

It might cause shudders in parents of junior infants but those with older children are used to receiving such warnings. A child is lucky to get through primary school without at least one infestation of the little critters, which seem adept at developing resistance to chemicals used to treat them.

Don’t let notification of a case of head lice panic you. Pharmacist Kathy Maher has parents coming into her looking for anti-parasitic lotions to apply “just in case”. Children should not be treated with an insecticide unless the parent is absolutely sure it is needed, she stresses – ask a pharmacist to check your child’s head if there is any doubt.

When it comes to minor childhood afflictions that can cause embarrassment, head lice is one most parents are prepared to discuss with each other. But how about worms or scabies or molluscum contagiosum? You are less likely to hear mention of those at the school gate.

As a result, parents who know little or nothing about such conditions are alarmed to see symptoms in their children and may be reluctant to ask for advice, so they go straight to the doctor. With a little more awareness, they could save themselves the worry and the expense, and head to the pharmacy for an over-the-counter treatment instead.

Worms is a case in point. If you see them wriggling in your child’s faeces, there really is no doubt about the diagnosis and you don’t need a prescription for effective medication. Yet family doctors often have parents coming in asking what to do about them – and thinking that nobody else’s child has ever got them.

Jane freaked at the sight of threadworms in both her four-year-old son and two-year-old daughter. She informed the manager of her daughter’s creche in south Dublin who did not make her feel any better by remarking, “That is most unusual around here – how on earth did she get them?” Jane’s mortification was complete when a large notice went up informing other parents.

Worms in children is very common, stresses Dr Madeleine McCarthy of the Harbour Health centre in Dún Laoghaire, Co Dublin, and is easily treated with over-the-counter medication.

If you are uncomfortable at the thought of inquiring about “something for worms” in a crowded pharmacy, ask to have a quiet word with the pharmacist.

From November 1st, all pharmacies will be obliged by law to have a private consultation area and many already have. So you will be entitled to request privacy if you – or your child – are embarrassed at the public discussion of any conditions or symptoms.

It is important to bring the child with you if you are seeking a pharmacist’s advice, says Maher, who works in two Co Meath pharmacies, in Duleek and Donore.

Also be assured that if there is any doubt about the problem or its severity, a pharmacist will advise you to bring the child to the doctor.

Some parents feel cheated if they pay for their child to see the doctor and then walk out the door empty handed.

It is a “huge problem”, says Dr Louise Power, who works in a GP practice in Mullingar, Co Westmeath, and has a special interest in paediatrics. “Everybody wants antibiotics. They pay €50 to see you and feel hard done by if they don’t go out with something.”

It is difficult to convince them that nothing can be done about viral infections and they just need to treat symptoms, such as a raised temperature, with an over-the-counter children’s medicine.

“You have to be very strong to give them nothing,” says Power, who urges parents to see what they are paying for is the reassurance that it is nothing serious, rather than being disappointed at not getting a prescription.

Both she and McCarthy mention the viral skin infection molluscum contagiosum(little wart-like lumps) as one of those conditions which parents are very keen for doctors to "do something" about when, in fact, it is best left alone and will disappear itself.

“If everyone just realises what it is and lets it go, it will be fine,” says McCarthy. People are afraid to bring affected children to a swimming pool, but it is not that contagious and should not stop children doing anything.

Doctors can use cryotherapy – the application of liquid nitrogen – to remove the bigger lumps but Power does not recommend it.

Cryotherapy is also often requested for warts or verruccae. However, studies in the US have shown there is little, if any, difference between the effectiveness of it and treating them at home by covering them with duct tape for five days at a time and then paring them down.

The DIY method may be annoying for parents as it requires persistence, says McCarthy, but the freezing of them by the doctor can be painful for the child.

Here is a guide to 10 of the more common, less-talked-about minor childhood ailments, which may cause more distress to the parent than to the child. However, if a child is noticeably off form with any of them, a visit to the doctor is advised.

HEAD LICE

Head lice are small blood-sucking insects that live on the scalp. It is a myth that they are associated with poor hygiene – they are just as likely to infest those with clean hair. Head lice spread through close contact – they cannot hop, fly or swim but just crawl very quickly – and are most common among primary school children.

Symptoms: An itchy scalp, particularly behind the ears or at the back of the neck; however, some affected children will not have any symptoms.

Combing the hair with a fine-tooth comb should help you detect the creatures – or reveal their eggs (nits) stuck on the hair shaft.

Treatment: Treat with anti-parasitic lotions available from a pharmacist and then follow up with fine-tooth combing of the hair, treated with conditioner, every three or four days for a fortnight.

If you do not want to use an insecticide on your child, some parents have found that systematic fine-tooth combing alone can do the trick, or your local health store could offer you an alternative, natural product.

WORMS

Threadworm is the most common type of worm infection among children here. They are tiny worms that live in the intestine but come to the skin surface (around the anus) at night to lay eggs. Infection can be passed from child to child if they come in contact with contaminated food or objects such as towels. Ensuring they wash their hands before eating reduces the risk of eggs entering their mouth – which is how the lifecycle is perpetuated.

Symptoms: Itching around anus or vulva at night; visible in faeces.

Treatment: One dose of an appropriate over-the-counter, anti-parasitic oral medicine should clear them, but it is important the whole family is treated at the same time.

SCABIES

Fairly common skin infection caused by an infestation of the tiny parasitic mite Sarcoptes scabiei. The mites burrow into the skin, particularly in between fingers and toes, and in the arm pits. They are passed by direct skin-to-skin contact.

Symptoms: A rash that can be extremely itchy at night.

Treatment: An anti-parasitic cream or lotion, available over the counter. It is important that everybody in the family is treated at the same time.

MOLLUSCUM CONTAGIOSUM

A common viral infection which generally does not bother the child, other than perhaps embarrassment among older children.

Symptoms: Small white or pale pink wart-like lumps appear on the skin. A tiny dimple often develops on top of each lump, or molluscum, and there may be a "cheesy" discharge when they are squeezed.

Treatment: The lumps will disappear of their own accord and the recommended treatment is do nothing but be patient – it can take up to a year and a half for them to clear.

If a mollucsum becomes inflamed, antiseptic cream may be applied or, if it seems badly infected, check with a doctor.

HAND FOOT AND MOUTH

A common viral illness – not to be confused with the foot and mouth disease which afflicts cattle, sheep and pigs.

Symptoms: Small blister-like sores around the mouth, on the palms of the hands or soles of feet. The child may have a slightly raised temperature and be off form.

Treatment: No treatment; it will run its course within a few days.

CHILDHOOD THRUSH

A fungal infection, which thrives anywhere warm and moist and is most commonly seen in the mouths of babies. Thrush can also occur in the genital area in children.

Symptoms: Thick, white coating on the tongue or redness around the vulva area or penis.

Treatment: Anti-fungal creams applied to the affected area. However, severe or recurrent cases should be discussed with a doctor.

BALANITIS

This is a general name given to inflammation of the head of the penis, which may have a number of different causes including thrush, but is often due to a tight foreskin.

Symptoms: Rash, soreness or itching on the penis; there may be a discharge from under the foreskin.

Treatment: This will depend on what is causing it, and may include antiseptic cream or antibiotics or, in recurrent cases, circumcision.

WARTS/VERRUCAE

Small growths on the skin caused by infection with the human papilloma virus (HPV). Warts are usually painless, unless sited somewhere that they interfere with physical activity. A verruca is the name given to a wart on the sole of the feet, which is forced to grow inwards instead of outwards and is more likely to cause pain because of its location.

Symptoms: Appearance of a small bump with a rough surface that may have a black dot in the centre.

Treatment: A wart will probably disappear of its own accord within two years but if it is unsightly or painful, you might want to get rid of it sooner. Research in the US, led by Dr Dean Focht of the Children's Hospital Medical Center in Cincinnati, concluded that the DIY use of duct tape stuck over a wart for five days at a time and then paring it down is just as, or even more, effective as cryotherapy (the application of liquid nitrogen by a doctor or chiropodist) in removing it, but the process does take longer – up to two months. Over-the-counter remedies are also available.

SLAPPED-CHEEK DISEASE

A viral infection which is not contagious once the rash appears – so no need to keep children off school, unless they seem unwell.

Symptoms: Bright red cheeks and a minority of children will have a slightly raised temperature and be off form. Not to be confused with scarlet fever, which also causes bright red cheeks but is a strep throat condition that needs medical attention.

Treatment: No action needed.

RINGWORM

A mildly contagious, fungal infection which appears in a typically circular pattern on the skin.

Symptoms: Circular lesion with a scaly edge that may be itchy.

Treatment: An over-the-counter, anti-fungal cream or lotion should clear it. If it appears on the scalp, a doctor needs to be consulted.