I think my baby has colic.
What can I do?

If your otherwise healthy baby is younger than 5 months old and cries for more than three hours in a row on three or more days a week for at least three weeks (yes, that's a lot of crying!), then he probably is colicky. Check with your doctor to be sure. 

Read on to learn how to help a colicky baby while keeping your sanity. Try different strategies, because what helps one colicky baby might not do anything for another. 

Check the bottle.
If your baby's bottle-fed, it's important to find a bottle that won't contribute to gulping. The more air a baby swallows while feeding, the more likely tummy trouble will be.
The nipple should have a hole that's not too small, which could frustrate him and make him gulp for more food, or too large, which would cause the liquid to come at him too quickly.

Some bottles are specially designed to reduce air intake. Some are curved, while others have internal vents or liners, which prevent air bubbles from forming in the liquid and keep the nipple from collapsing.


Keep feedings upright.
You might try holding your baby more upright during feedings to help the formula or breast milk travel more smoothly to his tummy. If he's curled up or hunched over, he's more likely to trap some air in there with his food.

Eliminate frantic feedings.
Feed your baby before he's starving — if he's crying from hunger, he's more likely to gulp air along with his meal. Try to feed him in a calm environment: Turn down the lights, put on some soft music, and ask siblings to play quietly (you can always hope).

Burp him often.
Frequent burping will help get air bubbles out of your baby's tummy. Don't wait until he's finished a full-course feeding to burp him. Prop your infant up for a burping when you change sides during nursing or every few minutes when bottle-feeding.
 
Adjust your diet if you're breastfeeding.
If you think that your baby may be sensitive to something in your breast milk, try eliminating dairy products (milk, cheese, yogurt) for a couple of weeks, which is how long it takes for the cow's milk protein to work its way out of your milk.

If that doesn't do the trick, you might take a look at spicy foods, wheat products, nuts, strawberries, cruciferous vegetables (such as cabbage, broccoli, and cauliflower), garlic, caffeine, and alcohol. Stop eating likely offenders for a few days, then introduce them one at a time, waiting to see if your baby reacts to one item before introducing the next. The process may take a while, but if it saves your baby any crying time at all, it's worth it.

Ask about a formula change.
Formula doesn't often cause colic, but if your baby is colicky, a change may be worth a try. Ask your baby's doctor about switching to a formula that doesn't contain cow's milk protein.

Try an over-the-counter solution.
Some parents of colicky babies have great luck with gripe water (a preparation made from herbs and sodium bicarbonate) — although there's no scientific evidence that it works. 
If you think gas is what's bothering your baby, you might want to try over-the-counter anti-gas drops (simethicone). Make sure you're buying drops created specifically for babies, and — as with any medication — get your doctor's okay before using it.
 
Massage your baby.
A gentle belly rub might help dispel gas or at least help your baby's tummy — and psyche — feel better. You might also try placing your baby across your knees, tummy down, and rubbing his back. This sometimes helps release excess pressure.

Use a (warm) hot water bottle.
Some babies appreciate the feeling of warm water against their belly. Fill a hot water bottle with lukewarm water and wrap it in a towel. Place it on your belly and let your baby lie on top of you. Be very careful not to make the water too hot, though — what feels warm to your tummy may be too hot for your new baby's skin.

Get noisy.
Babies like sounds that remind them of the rhythmic heartbeat and whooshing noises they heard in the womb. Your baby might be comforted to sit in his infant seat near the clothes dryer as it's running or in a front pack while you vacuum. Or he might calm down when the exhaust fan is on in the kitchen.

Make music.
Sing to your baby or try a CD of lullabies or other gentle tunes. You can even find CDs of soothing womb sounds. On the other hand, some parents report that their colicky babies prefer loud rock!

Move it.
Babies are comforted by gentle motion of all kinds, so invest in a rocker, baby swing, or simple bouncer. Your baby might also find it soothing to be walked around the house in a front pack or sling. Keep in mind that he may prefer being held higher in the pack, close to your chest and your heartbeat. Try gently bouncing up and down in this position while hugging your baby close.
 
Do the baby bicycle.
Put your baby on his back. Hold his feet and gently move his legs in a bicycling motion several times a day.(nappy changes are a good time to try it.) For some babies this relieves gas and other tummy discomforts.

Get behind the wheel. Many parents find that a ride in the car — with its movement, noise, and vibration — is the best remedy for colic. Buckle your baby into his car seat and go for a drive to get a change of scenery for you and (possibly) relief for your baby.

Try a different atmosphere.
If you've been indoors, it may help to take your baby out for a walk, either in the stroller, a sling, or a front pack. The new sights, sounds, and smells may distract him, and the fresh air and rhythmic movement of walking may calm him and allow him to fall asleep. On the other hand, if you've been out and about with your baby all morning, some quiet time at home might be just what he needs.

Hush!
While some babies are comforted by motion, noise, and activity, others need less stimulation and respond better to quiet, stillness, and darkness.

Swaddle.
Think about how snug your baby was before his birth, and you'll have a good idea how wide the world seems to him right now. Swaddling — an ancient method of wrapping your infant in a blanket or cloth — can help a baby feel less out of control. You can try swaddling your baby during feedings if he has trouble focusing on his meal, or wrap him up before his usual colicky period or before you put him down to sleep.

Not only might swaddling help your colicky baby get to sleep, there's a good chance it will help him stay asleep, too. Researchers have found that babies who are swaddled sleep more soundly than those who aren't. That's because when a baby twitches during sleep, his own movements can wake him up. Swaddling keeps that little twitch from becoming a full-fledged flail he's unlikely to sleep through.

The swaddling technique is easy to master. Once you find that your baby loves to be swaddled, you may even want to invest in a special swaddling bunting.

Scent the environment.
Some babies respond well to scent. Aromatherapists develop specific essential oil formulas for a variety of problems and conditions, from headaches and fatigue to anxiety and fear.

You might try one developed for calming and soothing nervousness. (Some are made specifically to help calm babies.) A spritz of chamomile in the bedroom or a lavender-scented bath might also do the trick (if not for your baby, then for you).

Bathe your baby.
A warm bath in the middle of your baby's colic time might distract and relax him enough to help. Some babies also love to be held in the shower, with the spray on their back. Your baby may enjoy the rhythmic beating of the warm water as well as the sound.

Offer a pacifier.
Anything that helps your baby calm down is priceless right now. For some babies, sucking is the ultimate soother. So you might want to try offering a dummy, even if you ordinarily wouldn't. Or encourage your baby to suck on his finger by gently putting it in his mouth.

Stick to a routine. You'll want to feed your baby whenever he's hungry, but otherwise he might find some comfort in a set routine — baths, walks, naps at certain dependable times. Your baby isn't watching the clock, of course, but he does carry a sense of the rhythm of his days.

How to keep your sanity

An inconsolable baby is a tough trial for a new parent. It's enough to make you cry. Go ahead. Also keep in mind:

It's not personal.
When your baby spurns your attempts to console him or seems angry with you, remind yourself that he's too young to comprehend the concept of blame. And while there are things that you can do to try to console him, his having colic has nothing to do with your parenting skills.

You can't do it alone.
Share baby care with your partner. Have a friend or relative take over for you once in a while so you can take a peaceful walk or a refreshing shower.

If you find yourself becoming angry or frustrated with your baby, take a deep breath and gently lay him in his crib. Then call a friend or a relative to come and stay with your baby while you calm down.

You're helping your baby, even if he's still crying.
You may not be able to keep your baby from crying. In fact, it's possible that crying is exactly what he needs to do, and you can best help him by respecting and accepting that. Continue to hold him, rock him, whisper to him — and let him cry, all the while assured of your love.

Natural Ways to bring on Labour

 Natural ways to bring on labour - some common beliefs -

For the past 40 weeks you've been waiting for this moment. Your birth plan is written, your bag is packed, and you're sure that any minute now you will feel your first contraction. And then... nothing. Not even a twinge.

Now there is something to be said for being patient. Your baby will come when he's ready. But if an induction date is looming, you might feel like you want to give him a gentle nudge. 

Acupuncture

Acupuncture involves the insertion of needles into specific points of your body. This is thought to stimulate the energy within your body to act on a specific organ function or system

Castor oil

We don't know exactly how castor oil works. It's thought that it stimulates your tummy and therefore stimulates your uterus (womb), kick starting labour. However, be aware that taking castor oil may make you nauseous and give you diarrhoea which is the last thing you want just before or during labour.



Curry

Curry is often suggested as a means to bring on labour. Eating spicy food may stimulate your tummy and therefore stimulate your uterus into action  


Pineapple

Pineapple contains the enzyme bromelain which is thought to help soften your cervix and bring on labour. Eating large amounts will probably stimulate your tummy, which could also stimulate your uterus 

Herbal remedies

Herbal remedies such as blue cohosh and black cohosh are much stronger thanhand homoeopathic remedies should be used with caution. Blue cohosh in particular has been linked to complications for babies at birth. You should get professional guidance before using herbal remedies as they are much stronger than homoeopathic remedies 

Homeopathic remedies

Homeopathic remedies such as pulsatilla are often used to stimulate labour. There is lots of anecdotal evidence from mums-to-be who have found them helpful. However, talk to your doctor or midwife before trying them 


Nipple stimulation
Nipple stimulation is when you gently rub or roll your nipples to encourage the start of contractions. The idea is to stimulate the suckling of your baby. This releases oxytocin, a hormone which causes contractions to start  


Raspberry leaf

Raspberry leaf can be taken as a tea or in tablet form. It is thought it may stimulate your uterus and encourage labour 


Sex

Having sex can be tricky when you have a big bump. But it could trigger the release of oxytocin, a hormone which causes contractions. Having an orgasm could also stimulate your uterus to get labour going


Walking

The pressure of your baby's head pressing down on your cervix from the inside could stimulate the release of oxytocin, a hormone which causes contractions. Being upright also encourages your baby to move down onto your cervix 


And finally:

Here is a selection of other methods (some of them a little bizarre) that other mums are said to have found helpful. There is no evidence for any of these and frankly we are not convinced!

• Blowing up balloons: the theory is that the build up of abdominal pressure encourages labour to start.


• Bouncing on your birth ball or driving your car down a bumpy road would seem to put the same faith in shaking things up a little.


• Get a weepy video and have a good cry.


• Wear your best knickers (sod's law will ensure that your waters break in them).

Postnatal Depression

Postnatal depression usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months.

There are many symptoms of postnatal depression, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware they have the condition.

It's common to experience mood changes, irritability and episodes of tearfulness after birth – the so-called baby blues. These normally clear up within a few weeks. But if a woman experiences persistent symptoms, it could well be the result of postnatal depression.

PND Symptoms 

Postnatal depression can affect women in different ways. Symptoms can begin soon after the birth and last for months, or in severe cases for more than a year.

Key symptoms are:

• a persistent feeling of sadness and low mood

• loss of interest in the world around you and no longer enjoying things that used to give pleasure

• lack of energy and feeling tired all the time (fatigue)

• disturbed sleep – such as not being able to fall asleep during the night (insomnia) and then being sleepy during the day

• difficulties with concentration and making decisions

• low self-confidence

• poor appetite or an increase in appetite (‘comfort eating’)

• you become very agitated or alternatively you become very apathetic (can’t be bothered)

• feelings of guilt and self-blame

• thinking about suicide and self-harming

Postnatal depression can interfere with your day-to-day life. Some women feel unable to look after their baby, or feel too anxious to leave the house or keep in touch with friends.


What causes PND?

PND can happen whatever your family circumstances, and whether or not the baby is your first. You may have managed happily with your first baby and yet become depressed after your second, or the other way around. There is no one cause for PND, but a number of different possibilities have been put forward to explain why new mothers may become depressed in this way.

The shock of becoming a mother

Women are often unprepared for the physical impact of childbirth, and yet motherhood has further shocks in store. There are new and daunting skills to learn, and this is only the beginning. You are suddenly responsible, 24-hours a day, for a helpless human being whose only communication is crying, which we as adults associate with distress. Some new mothers become very anxious about their babies, feeling overwhelmed by the responsibility of looking after them, and lying awake at night listening for their breathing and fearful of cot death.

As a new mother, you may find you can't go out without the baby, and that you may not even want to. Neither can you leave the baby alone in the house. Suddenly your own freedom to come and go as you please has disappeared. When you do take the baby out, the pram or buggy turns familiar routes into obstacle-courses, and buses and shops are suddenly hard to use. All too often, you may find yourself alone in the house, with no adults to talk to. And you may feel totally exhausted. All this takes getting used to. Becoming a mother involves many losses, not only of freedom, but also of income, of independence, and of your sense of who you are.

Changed relationships

Becoming a mother can be a huge change of role. It alters the relationship between you and your partner. Two adults, who may have had few joint responsibilities previously, are suddenly parents. It will affect your relationship with your own mother, too. You're no longer your mother's little girl but, instead, have turned her into a grandmother. This is a further loss, as well as a gain, which both sides have to adjust to.

You may well have given up a job, if only temporarily, and will find yourself financially dependent on someone else, perhaps for the first time in your adult life.

Even when the baby is a second or third one, there are still adjustments to be made, because each new baby changes the family as a whole. In a way, it gives birth to a new family, and all its members have to get used to that.

Help with adjusting

Twenty years ago women often used to spend a week in hospital following the birth of their baby, recovering, and being fed and supported while they learned to feed and care for the infant; nowadays they often go home on the day of the birth, with little or no professional support. One study of experiences of new mothers suggested that lack of support was a key cause of PND. Home births may mean that more support is available, both from the midwife who attends the birth, and from family and friends.

Lack of support

It's easy to ask too much of mothers and motherhood. On the one hand, society idealises motherhood, requiring mothers to be open-armed, ever-giving sources of food and love. On the other, they are expected to achieve this impossible perfection by magic. Mothering is thought of as instinctive, not something that needs to be learned.

In the past, women learnt about motherhood in the large families that used to be common. When they became mothers, in turn, they could expect to call upon the help of their female relatives, young and old. Nowadays, many new mothers have to cope on their own, with, or without the help of their partner, and often neither of them has any previous experience. Not having these skills can feel like a crippling personal failure.

Other stresses to cope with

If you are under additional strain for any reason, you are more likely to become depressed. The cause could be an illness or death in the family, or because you are moving house or changing your job. Or it could be the result of longer-term difficulties, such as being unemployed, on a low-income or in poor housing.

You may be going through other life experiences which make it harder for you to cope with giving birth. Women who are giving birth in an unfamiliar environment, such as recent immigrants, refugees or asylum seekers, are likely to be more vulnerable to PND. Giving birth in a high tech hospital environment, surrounded by strangers rather than at home with family, brings many extra stresses, and women may feel unable to follow comforting rituals or practices which are an important part of their culture.

Evidence suggests that a new mother is more likely to become depressed if she has no-one to confide in, has no job outside the home and has three or more children under 14 years old living with her. These are all factors that involve some kind of loss and low self-esteem.

Difficult labour

If you are unfortunate and have a difficult labour with a long and painful delivery, an unplanned caesarean section or emergency treatment, you may be suffering from a form of post-traumatic stress disorder rather than postnatal depression. The impact of this has been under-estimated, as people may feel that the baby is adequate compensation for the trauma and the new mother will soon forget the ordeal in the joy of motherhood; but traumatic childbirth may impair your relationships both with your baby, and your partner. You may feel acute disappointment that childbirth was not the wonderful experience you were hoping for, and feel angry with the obstetricians and midwives if you felt that the delivery was mismanaged. Many mothers avoid further pregnancy after a negative birth experience. Women who suffer traumatic childbirth should be treated for trauma and helped to put the experience behind them, to minimise the risk of developing long-term depression.

Changes to your body

You may also feel upset at the appearance of your body after childbirth. You may have unrealistic expectations about how soon your body may return to its normal size and shape after giving birth, and be upset by stretch marks or scars. Usually weight is lost gradually over a period of months rather than weeks, and scars will fade with time.

Hormonal upheaval

The hormones oestrogen and progesterone affect our emotions. Levels of progesterone are very high during pregnancy and some doctors believe that PND can be caused by the sudden drop in progesterone after the birth. But when women were given progesterone to try and prevent depression it had the reverse effect and the depression got worse, whereas treatment with an oestradiol patch is found to be helpful.

Diet

There is some evidence to show that a lack of certain nutrients during pregnancy can lead to depression; these include omega 3 oils (found in oily fish, seeds and nuts), magnesium (leafy green vegetables and seeds) and zinc (seeds and nuts). Poorly controlled blood sugar levels – caused by irregular eating or omitting the right types of food – can also have the same effect. 

Childhood experiences

Your own childhood experiences can have a huge influence on the present. Sometimes, long-buried hurts can be forced to the surface by the shock of giving birth. In particular, if you were separated from your own mother for any length of time before the age of 10 or 11, you could be more vulnerable to postnatal depression. The separation could be because of illness, death or war. Or it could have been through being sent away to relatives (for the birth of a sibling, perhaps) or to boarding school. Some of these events might have been seen as unremarkable at the time, but they may still have been traumatic for you as a child. When these old sorrows emerge, in the form of depression, it can be frightening and bewildering. It's also potentially healing. With the right kind of support, you may be able to let go and move on. 

Perinatal depression

The term 'perinatal' means around the time of birth – both before and after. Although depression is thought to be most commonly experienced by new mothers soon after the birth, some women experience depression during pregnancy, and research has suggested symptom scores for depression are higher during pregnancy than after the birth. One study has suggested that depression may in fact be more common before the birth than afterwards.

What can I do to help myself get better?
PND usually gets better in time, although it may take up to a year. Love, support and nurture from family, friends and community can be vital in helping you to cope.

Treatments 

Prescription medicine

A GP can prescribe various different kinds of medication to help, and it's important to discuss this fully, before taking any, and to keep monitoring progress. It is very important to remember that medication may enter breast milk, and if you are breastfeeding you will need to bear this in mind when deciding whether or not to take it. Some drugs have known effects on infants, while others appear to be quite safe, so it is important to discuss this with your doctor.

Manufacturers advise that the following antidepressants should be avoided while breastfeeding: doxepin; phenelzine, isocarboxazid, moclobemide; citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline; duloxetine, venlafaxine; flupentixol, mirtazapine, reboxetine, and agomelatine.

Lithium, benzodiazepine tranquillisers and sleeping pills, zolpidem, zopiclone, and bupropion should also be avoided if you are breastfeeding.

All other drugs should be used with caution; talk to your doctor or a pharmacist if you need more advice about a particular drug.

If you do decide to try medication, it may be necessary to try different drugs to achieve the best results. All antidepressants take time to work. They also all have possible side effects, and when you stop taking them you should withdraw slowly, to avoid possible withdrawal effects which can be unpleasant. If you do take them, they can be very effective, and you should be prepared to take them for at least six months.

Counselling and psychotherapy

Talking treatments, such as counselling and psychotherapy, offer you the opportunity to look at the underlying factors that have contributed to the PND, as well as helping you to change the way you feel. Many GPs have a counsellor or psychotherapist attached to the practice. They can also refer patients to a psychiatrist or psychologist on the NHS. Various organisations offer talking treatments, and some of them operate a low-fee scheme for those who can't afford to pay.  Cognitive behaviour therapy is increasingly popular as a short-term treatment, providing you with practical strategies for dealing with problems 

What about fathers?
Although postnatal depression is mainly a problem for mothers, with causes that are at least partly physiological, in recent years it has increasingly been recognised that new fathers also become depressed. It has been suggested that as many as 1 in 25 new fathers are affected. The causes include the pressures of fatherhood, increased responsibility, the expense of having children and the change in life-style that it brings, the changed relationship with their partners, as well as lack of sleep and increased workload at home. Research has shown that in families where fathers were depressed soon after the birth, the children were at increased risk of emotional and behavioural problems, and boys were more affected than girls.

Depression in fathers is frequently associated with postnatal depression in mothers, and as with mothers, the father's depression may begin during the pregnancy, when relationships are already changing and they may feel left out while their partner is receiving increased attention as a pregnant woman. Studies have found that both midwives and health visitors may see fathers as problematic and potentially violent, and may marginalise them while working with the family. This may be exacerbated by the fact that men often express depression as hostility, and frequently lack close relationships with people they can confide in. Few services exist for men, although awareness and understanding of this problem is improving slowly.

Spotting the signs in others
Many mothers do not recognise they have postnatal depression, and do not talk to family and friends about their true feelings.

It's therefore important for partners, family members and friends to recognise signs of postnatal depression at an early stage. Warning signs include:

• they frequently cry for no obvious reason
• they have difficulties bonding with their baby
• they seem to be neglecting themselves – for example, not washing or changing clothes
• they seem to have lost all sense of time – often unaware if ten minutes or two hours have past
• they lose all sense of humour and cannot see the funny side of anything
• they worry something is wrong with their baby, regardless of reassurance

If you think someone you know has postnatal depression, encourage them to open up and talk about their feelings to you, a friend,  GP, or health visitor. 

Postnatal depression needs to be properly treated and isn't something you can just snap out of.

Some sites with more information & support:http://www.mind.org.uk/help/diagnoses_and_conditions/post-natal_depression#causes
http://www.nhs.uk/conditions/Postnataldepression/Pages/Introduction.aspx
http://www.patient.co.uk/health/Depression-(Post-Natal).htm

What is separation anxiety?

  

At some point during their development, all babies will experience separation anxiety. This is very common and completely normal, however, it can be difficult for parents to cope with a baby who gets panicky and upset when they’re not around. The good news is, for the vast majority of babies, separation anxiety happens in phases and won’t last forever.
This article explains what separation anxiety is, its causes and suggests techniques on how you can deal with it.
It often starts at around eight months and usually subsides as your baby nears one year old or a few months after. However, it may come back sometime around two years, once your baby becomes aware of their own independence.

One afternoon you’re playing with your eight month old baby on the floor who’s just started to shuffle around on her bottom and you need to nip to the loo. A pretty normal occurrence and one that your baby hasn’t reacted to particularly strongly before. But today, the second you leave the room, your baby starts crying and screaming, and will only be consoled by you holding and comforting her.
This is an example of separation anxiety, which a baby experiences when separated from the main person who looks after them, usually mum. Rather than this being a sign that something is wrong, separation anxiety is in fact (noisy!) proof of just how strong the bond between you and your baby is.

What causes it?
From around the age of six months, your baby will start to engage more actively with the world around them. During this time they will also learn how to differentiate, or recognise faces - mostly those of the people who look after them - and they will feel comfortable with familiar people and environments.
However, while they might have been happy being held or comforted by people other than yourself or your partner before, this now might lead to them screaming with panic. This is a natural reaction because even if they recognise the person holding them - what they don’t know and what upsets them – is not knowing when, or if, you will return.

Dealing with separation anxiety
Your baby will learn – through the responsiveness of those close to them – to recognise when there really is something to be upset about and the patterns of your comings and goings in their day and life. However, this is not something babies learn overnight.
The best way to deal with separation anxiety is to give your baby reassurance - over and over again - that your absence doesn't mean that you have gone away forever.
Even if your baby's distress is upsetting you, it's not necessary to give up plans to go out or return to work. It's part of her emotional growth to learn that others can care for her as well, and she can trust you to come back soon.
Some babies are comforted by the presence of a soft toy or blanket which they associate with you or your partner perhaps. But patience, understanding and calm reassurance are the main responses you can use to handle separation anxiety. Other common strategies include:

• Timing: Try not to leave when your baby is likely to be tired, hungry or restless. If possible, schedule your departures for after naps and mealtimes.
• Practice: Leave your child with a relative or friend for brief periods initially. If you’re planning to leave your baby with a relative or babysitter invite that person over in advance so they can meet them beforehand.
• Consistency: Have a regular group of people who look after your baby and interact with them.
• Familiarity: Keep surroundings as familiar as possible and make new surroundings more familiar. If your baby is starting a new nursery make a few short visits there before a full-time schedule begins.
• Ritual: create a goodbye ritual during which you say a calm, loving and firm goodbye. Don’t sneak away when she is not looking. Reassure her that you’ll be back. When you leave mean it, as returning will make things worse.
• Follow through: Make sure you return when you promised and your child will develop the confidence that she can make it through the time apart.

The best way to deal with separation anxiety is give your baby reassurance – over and over again – that your absence doesn’t mean that you have gone away forever.

Websites for advice and support:

http://www.nct.org.uk/parenting/separation-anxiety-0

http://www.babycentre.co.uk/baby/development/socialandemotional/independence/

http://www.webmd.boots.com/anxiety-panic/separation-anxiety

Bed Wetting an introduction

 
Bedwetting can be a worrying and frustrating, but it's extremely common for children to accidentally wet the bed during the night. The condition will often resolve itself in time. 

You may hear your doctor refer to bedwetting as nocturnal enuresis.

Medical treatments aren't usually recommended for children under the age of five as it's common to wet the bed at this age (though exceptions can be made if a child finds bedwetting particularly upsetting).

Bedwetting usually only becomes a concern in children who are five years of age or over and who are wetting the bed at least twice a week.

Although bedwetting doesn't pose a threat to a child’s physical health, it can have a considerable psychological impact on their self-esteem and confidence, particularly in older children.

So if your child is experiencing frequent bedwetting and is finding it upsetting, it's recommended that you contact your GP for advice.

Bedwetting can also be a frustrating and upsetting problem for parents, not only coping with its effects on the child, but having to deal with the practical and financial consequences, such as continually washing bedclothes.

Reassuring your child

Reassuring your child that everything is okay is very important if they regularly wet the bed. Your child should know that:

• it's not their fault
• they're not alone
• it will get better

You should also never tell off or punish a child who wets the bed. Not only can this cause distress, it's also likely to make the problem worse.

It is important to let your child know that his bed wetting can be solved, but you have to make sure that he understands that there is a process to follow. Sometimes, this may mean that he has more things to do before going to bed, like maybe set an alarm, but this is nothing different, than say, a child having to wear glasses. 

What are the treatment options for bed wetting?

Not using any treatment is an option, as most children will eventually stop bedwetting. The older a child becomes, the more likely that bedwetting will stop. However, treatments often work to achieve dryness sooner rather than later. Treatment options include the following:

Bedwetting alarms

A device called a pad and bell or a similar alarm device is a common treatment. There is a good chance of cure, particularly for children aged seven and older (when up to 8 in 10 children are cured). An alarm is usually needed for 3-5 months to condition the child to wake and empty their bladder when it is full. Briefly, the alarm goes off as soon as wetting starts. This wakes the child and prompts him or her to go to the toilet. In time, the child is conditioned to wake when their bladder is full before they begin to wet. Alarms can be borrowed from your local continence advisor. Your doctor can advise about this. 

Medicines  

Desmopressin is the common medicine used for bedwetting. It works by reducing the amount of urine made at night by the kidneys. It usually works well (in about 7 in 10 cases), and straight away. If it works, a common plan is to take it for three months and then try without it. However, when it is stopped, the bedwetting often returns. (A permanent cure following treatment is more likely with bedwetting alarms than with desmopressin.) Desmopressin can also be useful for short spells. For example, during holidays or for times away from home. 

Reward systems

Briefly, you agree a reward with your child if they achieve a goal. Often the goal is not a complete dry night (as most children who wet the bed have no control over their wetting.) An agreed goal could be: going to the toilet before going to bed, getting up and telling the parents they are wet, helping to remake the bed, etc. A goal of a dry night may be appropriate in some cases when the situation is improving. A common example of a reward system is a star chart. This is simply a calendar with a space for each day. A child places a sticky star on each day following a good night (where the goal was achieved) and left blank for a poor night. You may agree a reward for a number of stars.
 
Do not punish children for bedwetting. It is not their fault. Rather, they should be praised and made a fuss of if you notice any improvement. Try to be sensitive to any family or school disruption that might be stressful to your child. If bedwetting appears after a period of dryness, it may reflect a hidden stress or fear (such as bullying at school, etc).

Explaining to children

It needs your child's co-operation to be dry at night. As soon as your child is old enough to understand, a simple explanation on the following lines can be helpful. "The body makes water (wee) all the time and stores it in the bladder. The bladder is like a balloon which fills up with water. We open the bladder's tap when the bladder gets full. The bladder fills up at night when we are asleep. However, the bladder tap should not go to sleep, and should wake us up when the bladder is full."

Child's responsibility

When old enough (about age five or six), encourage your child to help change any wet sheets. It may be quicker for parents to do it, but many children respond to being given responsibility. It might also give extra motivation for them to get out of bed and go to the toilet to avoid the chore of changing the sheets. Try to make it a matter-of-fact routine with as little fuss as possible.

Getting up

Make sure there are no hidden fears or problems about getting up at night. For example, fear of the dark or spiders, getting up from a top bunk, etc. Try leaving the bathroom light on.

Drinks

Restricting drinks sounds sensible, but it does not help to cure bedwetting. The bladder has to get used to filling up and holding on to urine. If you limit drinks all day then the bladder cannot be trained to hold onto larger amounts of urine. A sensible plan is only to give drinks to your child if he or she is thirsty in the 2-3 hours before bedtime. Do not restrict drinks for the rest of the day. Most children should drink about 6-8 cups of fluid a day. 

Also, as mentioned above, caffeine in tea, coffee, cola and chocolate may make bedwetting worse. These are therefore ideally avoided, especially in the few hours before bedtime.

Lifting

It is common practice to wake children up to take them to the toilet several hours after they go to sleep. However, this lifting is of little use, and may even prolong the problem. Your child has to get used to waking up when their bladder is full. Children often do not remember being lifted, and it usually does not help to achieve their own bladder control. 

However, make sure your child goes to the toilet just before bedtime. If your child does wake in the night then you should encourage them to go to the toilet then.

Constipation

If your child is constipated, see a doctor for advice and treatment. Treatment of constipation often cures bedwetting too.

Nights away

A common worry is that staying with friends or relatives will be embarrassing. However, it is not uncommon to find that the bedwetting stops for the nights away in a strange bed. A few days away with an understanding relative or friend may result in dry nights. This may be a very positive experience and encouraging for your child.

Practical measures

Use waterproof covers for mattress and duvet, and use absorbent quilted sheets. A moisturiser cream is useful to rub on the skin that is likely to become wet, to prevent chaffing and soreness
 
Websites for advice and support:
 
http://www.bedwetting.co.uk/help-child-bedwetting.html
 
http://www.nhs.uk/conditions/Bedwetting/Pages/Introduction.aspx
 
http://www.patient.co.uk/health/Bedwetting.htm
 

What is Childhood Asthma?
 
Asthma is a common long-term condition that can be well controlled in most children. The severity of asthma symptoms varies between children, from very mild to more severe. 

In the UK, over 1.1 million children have asthma. It is more common in young boys than young girls. However, this changes as children get older and, after puberty, asthma is more common in girls.

During the teenage years, the symptoms of asthma may disappear. However, asthma can return in adulthood. If the childhood symptoms of asthma are moderate to severe, it is less likely that the condition will get better in adolescence and more likely that it will return later in life.

The cause of asthma is not fully understood. It is known that asthma often runs in families and a child is more likely to have asthma if one or both parents have the condition.

What is asthma?

Asthma affects the airways, the small tubes that carry air in and out of the lungs (known as the bronchi). If your child has asthma, the airways of their lungs are more sensitive than normal. When your child comes into contact with something that irritates their lungs, known as a trigger, their airways become narrow, the lining becomes inflamed, the muscles around them tighten, and there is an increase in the production of sticky mucus or phlegm. This makes it difficult to breathe and causes wheezing, coughing, shortness of breath and can make the chest feel tight.

A sudden, severe onset of symptoms is known as an asthma attack, or an acute asthma exacerbation. Asthma attacks can sometimes be managed at home but may require hospital treatment. They are occasionally life threatening. 

Common triggers

A trigger is anything that irritates the airways and causes the symptoms of asthma. Everyone’s asthma is different and people may have several triggers. 

The most common trigger of an asthma attack is having an upper respiratory tract infection, such as a cold or flu. Other common triggers include:

• exercise, especially in cold weather
• an allergy to and contact with house dust mites, animal fur, grass and tree pollen
• exposure to air pollution, especially tobacco smoke

 
 
Websites for advice and support:
 
http://www.asthma.org.uk/about-asthma/my-child-has-asthma/asthma-your-child/
 
http://www.childhoodasthma.co.uk/
 
http://www.patient.co.uk/doctor/diagnosing-childhood-asthma-in-primary-care

What is Childhood Epilepsy?
 
In the UK, there are an estimated 60,000 children under 18 with epilepsy. Epilepsy can start at any age including childhood. If your child develops epilepsy you may have questions or concerns. This page aims to answer some of these questions and gives a brief introduction to how epilepsy can affect children. It also includes specific information about education for parents and teachers. 

What is epilepsy?
 
Epilepsy is a neurological condition (affecting the brain and nervous system) where a person has a tendency to have seizures that start in the brain.

The brain is made up of millions of nerve cells that use electrical signals to control the body’s functions, senses and thoughts. If the signals are disrupted, the person may have an epileptic seizure (sometimes called a ‘fit’ or ‘attack’). 

Not all seizures are epileptic. Other conditions that can look like epilepsy include fainting (syncope) due to a drop in blood pressure, and febrile convulsions due to a sudden rise in body temperature when a young child is ill. These are not epileptic seizures because they are not caused by disrupted brain activity.What happens during a seizure?

There are many different types of epileptic seizure. The type of epileptic seizure someone has depends on which area of their brain is affected.

There are two main types of seizure: focal seizures (sometimes called partial seizures) and generalised seizures. Focal seizures affect only one side of the brain and generalised seizures affect both sides of the brain. Generally, adults and children have the same types of seizure, although some may be more common in childhood than adulthood.

Different seizures include: 

• jerking of the body (convulsions);
• repetitive movements;
• blank moments when the child is briefly unconscious; and
• unusual sensations, such as a strange taste in the mouth or a strange smell, or a rising feeling in the stomach.

In some types of seizure, a child may be aware of what is happening. In other types, a child will be unconscious and have no memory of the seizure afterwards.

Some seizures are more common in childhood. For example, absence seizures which can be very brief and are often mistaken for 'daydreaming' or not paying attention.

Some children may have seizures when they are sleeping (sometimes called 'asleep' or 'nocturnal' seizures). Seizures during sleep can affect sleep patterns and may leave a child feeling tired and confused the next day.

Why does my child have epilepsy?

Some children develop epilepsy as a result of their brain being injured in some way. This could be due to a severe head injury; difficulties at birth; or an infection which affects the brain such as meningitis. Epilepsy with a known structural cause like this is called symptomatic epilepsy.

For some children, their epilepsy has a genetic cause. This may be inherited from one or both parents, or it may be a change that happened in the child's genes (before they were born). Epilepsy with a likely genetic cause is called idiopathic epilepsy.

Everyone has a level of resistance to seizures, called a seizure threshold. This is included in the genes passed from parent to child. A child with a low seizure threshold may start having seizures for no obvious reason. However having a low seizure threshold doesn't always mean that seizures will start.
Other children in the family may have a similar seizure threshold but may not develop epilepsy
 

How is epilepsy diagnosed?

A diagnosis of epilepsy may be considered id your child had had more than one seizure. The GP will will usually refer them to a paediatrician (a doctor who specialises in treating children). You (and your child if they can) may be asked to describe in detail what happened before, during and after the seizure.

Having a video recording of the seizure can help the paediatrician understand what is happening. 

The paediatrician may also suggest a few tests to help with the diagnosis. These tests alone cannot confirm or rule out epilepsy, but they can give extra information to help find out why your child is having seizures.


 
Websites for advice and support:
 
http://www.epilepsysociety.org.uk/
 
http://www.epilepsy.org.uk/info/syndromes/childhood-absence-epilepsy
 http://www.patient.co.uk/doctor/Epilepsy-in-Children-and-Young-People.htm