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Health Builders Pathways

Health Builders Pathways are simple and easy to follow. A pathway is a guide containing advice and support for families and explains what you should do if your child is ill. These pathways provide step by step information on what children, young people and their families should experience when accessing health services.It will help families to make choices about the care of their children.

Feedback on this section

Select here for a PDF version of High Temperature Pathway Guidance for Parents & Carers.
If you would like to print out the Pathway information please do so from this document.


Is my child with a high temperature unwell?

A normal temperature is less than 37.5◦C.

The use of a digital thermometer gives the most accurate reading.

A high temperature alone in a child over 6 months is not a good guide to how ill the child is.

A high temperature in children and babies over 6 months is common and is usually due to a virus.  This usually gets better by itself within a few days.

Please note that very small babies may have low temperatures which may be worrying.

How to take a temperature

What to use:

  • Digital thermometers are recommended
  • Ear thermometer (not for babies)
  • Forehead strips may be used by families, but not by health professionals

It is not always possible to find a cause for high temperature. This is common.

When should I seek help?

Seek help for:

  • Baby under 3 months with a temperature above 38◦C
  • Baby 3-6 months with a temperature above 39◦C

For a baby or child over 6 months

If your child has any of the following seek immediate help:

  • Unusually sleepy or hard to  wake up
  • Pale or mottled skin (blotchiness, with different shades and colours)
  • Unusual breathing or, an unusual cry
  • A rash that doesn’t disappear with the tumbler test 
  • Fits (convulsion)
  • No wee or no wet nappy all day
  • Headache
  • Stiff neck
  • Discomfort with bright lights

Call 999 immediately if your child shows signs of a life threatening illness which may include:

  • Your child's colour becoming extremely pale or blue or both
  • Your child becoming unresponsive or you are unable to rouse them
  • Your child has a rash which you can see through a glass in the Tumbler Test

The Tumbler Test

If a rash appears, press a glass firmly against the skin. If you can still see the rash through the glass call 999 immediately (this PDF guidance includes an example image of this).

What can I do practically at home?

  • Offer small amounts of drinks (water/juice) often, or – aim for wee to be pale yellow
  • If your child is breastfeeding continue as normal
  • Keep the room cool (approx 18-20◦C)
  • Check your child regularly(including 2-3 times during the night)
  • Do the Tumbler Test if your child has a rash
  • Keep your child away from school or nursery while they have a raised temperature

What medications?

It is not necessary to use medicines to treat your child’s temperature. If your child has a fever and is distressed you can help to make them feel more comfortable by giving them either paracetamol or ibuprofen. Always follow the instructions on the bottle or packet or check with a health professional.

  • Paracetamol: Do not give to babies under 2 months of age, unless advised by a health professional
  • Ibuprofen: Do not give to babies under 3 months unless advised by a health professional
  • Asprin: Do not give to children & young people under 16 years old
  • Antibiotics: Do not give unless a bacterial infection is identified, the majority of children do not require antibiotics

People I can turn to for help

The key health professionals trained to help children with high temperature are; health visitors, school nurses, family doctors (GPs), out of hours doctors (CHoC), pharmacists, 111 and NHS Choices.

Friends and Family may be able to give advice.

What the health professional will do?

With you they will reach a clear understanding of your child's needs by:

  • Listening to you and your child’s concerns
  • Taking a full history
  • Usually carrying out a physical examination (including breathing rate and pattern, heart rate, activity and hydration) and they may arrange to test a sample of wee

With you they will agree a plan based on national guidance (NICE)*. The plan will depend on:

  • If the child is less than 6 months old
  • If there are signs of illness that need treatment
  • The need for further assessment

*NICE – National Institute for Health and Clinical Excellence (www.nice.org.uk)

The Plan

The plan will include:

  • Where to look after your child – most will stay at home
  • Advice on home care – including when to ask for help again
  • Expected length of illness and likely outcomes
  • If and when a review of your child is necessary this may be by your GP or in hospital

For some, the plan will include advice on:

  • Further assessment or tests
  • Attending nursery or school
  • Referral to hopsital may be for assessment in the first place, but may lead to admission

You will always receive:

  • A copy of this Health Builders High Temperature pathway

How will I know my child is better?

  • The most common outcome for children with high fever is to return to normal without treatment
  • The temperature will be normal (37.5◦C or less) within 5 days
  • Drinking, eating, weeing and sleeping will be back to normal

Feedback on this section

Select here for a PDF version of Diarrhoea & Vomiting (Gastroenteritis) Pathway Guidance for Parents & Carers.
If you would like to print out the Pathway information please do so from this document.


Is my child unwell?

When young children suddenly begin to have diarrhoea and vomiting this is usually caused by an infection in the gut. This illness is known as gastroenteritis.

What causes gastroenteritis?

The most common cause of gastroenteritis in children is a virus called the rotavirus. This virus is passed out in the stools (faeces) of someone with the infection. It can be transferred to food, objects and surfaces if the infected person doesn't wash their hands after going to the toilet.

The infection is usually then passed to someone else when they either eat contaminated food or touch a contaminated object or surface and then touch their mouth.

Young children are particularly vulnerable to this infection because they often forget to wash their hands after going to the toilet or before eating, and they have not yet built up a resistance to the rotavirus.

It's estimated that almost every child will have at least one rotavirus infection before the age of five and many children will have several episodes a year. Most infections occur among children under four years old.

When should I seek help?

Most children with Gastroenteritis get better without treatment.  You will normally be able to look after them at home.

Signs and symptoms to look out for are:

Green: (Monitor at Home)

  • Playing, eating and drinking normally

Amber: (Contact a Health Professional)

  • Passing urine less often than usual
  • Sunken soft spot (fontanelle) on their head
  • Have few or no tears when they cry
  • Have fewer wet nappies
  • Drowsiness
  • Tiredness
  • Dark coloured, strong smelling urine.
  • Becomes ill after foreign travel

Red: (Urgently Contact GP/A&E)

  • Temperature of 38°C (100.4°F) or higher in children younger than three months
  • Temperature of 39°C (102.2°F) or higher in children older than three months
  • Shortness of breath
  • Abnormally rapid breathing
  • Stiff neck
  • Swelling in the soft part of their head (fontanelle) in babies, 0-18months only
  • Blotchy red rash, which, unlike most other rashes, does not fade when you put a glass against it
  • Blood or mucus in their stools (faeces)
  • Green vomit or vomiting for longer than three days
  • Severe pain or swelling of their stomach 
  • Change in their normal mental state, such as appearing confused
  • Diarrhoea that lasts longer than a week
  • Symptoms of dehydration that persist or get worse, despite treatment with fluids and oral rehydration solutions
  • Extreme thirst
  • Feeling unusually tired (lethargic) or confused
  • Not passing urine for eight hours
  • Rapid heartbeat
  • Dizziness when you stand up that doesn't go away after a few seconds

People I can turn to for help

The information provided in this pathway is for parents or carers of children under 5’s with diarrhoea and vomiting. It gives advice on how to look after your child, the symptoms to look out for and what to do if your child’s symptoms get worse. It is not meant to be a substitute for advice from a doctor or nurse, or CHoC.

The following people can be contacted to get advice and guidance:

  • Your Family & Friends
  • Community Pharmacist
  • Health Visitor
  • School Nurse
  • GPs
  • NHS 111
  • Out of Hours (Cumbria Health on Call, CHoC)

Contact with a health professional will not necessarily be face to face. An initial consultation may be given over the phone, following this discussion the health professional may well ask to see your child.

What the health professional will do

With you they will reach a clear understanding of your child’s needs by:

  • Listening to you and your child’s concerns
  • Making an assessment of your child’s needs either on the phone or face to face

The plan will depend on:

  • The age of your child
  • If there are signs of illness that need treatment. Treatment might include:
    • Fluids to help re-hydrate your child
    • Paracetamol to aid in pain relief
  • The need for further assessment
  • As most infections are viral it is extremely unlikely that your child will need antibiotics

The Plan

The plan will include:

  • Where to look after your child – most will stay at home
  • Advice on home care – including when to ask for help again
  • Expected length of illness and likely outcomes
  • If and when a review of your child is necessary this may be by your GP or in hospital

For some, the plan will include advice on:

  • Further assessment or tests
  • Attending nursery or school
  • Referral to hospital may be for assessment in the first place, but may lead to admission

You will always receive:

  • A copy of this Health Builders Diarrhoea & Vomiting pathway

How will I know my child is better?

Diarrhoea often lasts for 5-7 days and in most children it will stop within 2 weeks.

Vomiting often lasts 1-2 days and in most children it will stop within 3 days.

When your child is feeling better and is starting to eat and drink more normally and is managing to keep fluids down and not have to go to the toilet, this is a good indication that the episode of D&V has finished.

Be aware that your child may still be infectious, even after they are feeling better (see page E for further information).

About Hydration

Severe diarrhoea and vomiting can lead to dehydration, which is when the body doesn’t have enough water or the right balance of salts to carry out its normal functions. If the dehydration becomes severe it can be dangerous. 

Children at risk of dehydration include; young babies, children who haven’t been able to drink enough during their illness and children whose diarrhoea and vomiting has been severe. 

Contact your healthcare professional, for instance your doctor, if your child develops any of the symptoms of dehydration listed below. Some of the symptoms of dehydration are:

  • Seeming unwell
  • Unusually irritable/lethargic
  • Passing less urine than normal
  • Pale or mottled skin
  • Cold hands and feet
  • Dry mouth
  • Lack of tears

How to prevent dehydration

If your child has gastroenteritis but is not dehydrated:

  • Keep feeding them as normal (for example, breast milk) and offer plenty of drinks 
  • Your healthcare professional, for instance your doctor, may recommend that you give your child a special fluid known as ORS (Oral Rehydration Salt Solution). ORS (e.g. Dioralyte / Electrolade) can help prevent dehydration from occurring. It is also used to treat children who have become dehydrated (see page C)
  • If you do not have any ORS, you can use sugary cordial or iced lollies to aid in rehydration
  • Fresh fruit juice and fizzy drinks should be discouraged, because these can make diarrhoea worse

Treating dehydration

How to treat dehydration at home

  • Most children who are dehydrated can be rehydrated by giving them ORS to drink.
  • Make up the ORS according to the instructions on the packet. Your healthcare professional can tell you how much your child should drink.
  • Give your child frequent, small drinks of ORS.
  • Your child may vomit a little when they start to drink the ORS.
  • Contact a healthcare professional if your child keeps vomiting or will not drink the solution.
  • If you are breastfeeding your child, continue to breastfeed in addition to giving the ORS.
  • If you do not have any ORS available or your child will not drink ORS you can use sugary cordial or iced lollies to aid in rehydration.
  • Fluids should be given ‘little and often’.

Your child should not eat solid food until they are rehydrated.

It usually takes about four hours to complete rehydration.

Going to hospital

Your child may need to go to hospital if they won’t drink the ORS, or keep being sick, or if the dehydration is severe, or if the healthcare professional is concerned.

Treatment in hospital will include:

  • Assessment
  • Possible treatment with ORS
  • Observation for a period of time
  • A small number of children may need blood tests or other interventions

Caring for your child after rehydration

  • It’s important your child eats well after they are rehydrated, to help with recovery. 
  • Your child can start to eat solid food straight away.
  • Your child should drink plenty of their usual fluids. This should include breast or other milk feeds (full fat). 
  • You should avoid giving your child fresh fruit juice or fizzy drinks until the diarrhoea has stopped. 
  • Your healthcare professional, for instance your doctor, may also recommend that your child drinks rehydration solution after each bout of diarrhoea.
  • Simple foods should be given to your child after they have been rehydrated e.g. a plain biscuit or dry toast.

Preventing the spread of gastroenteritis

Everyone in your household should wash their hands regularly; this is the best way to help stop other people getting gastroenteritis.

You and/or your child should wash your hands with soap (liquid if possible) in warm running water and then dry them carefully:

  • after going to the toilet  
  • after changing nappies
  • before touching food

Your child should not:

  • share his or her towels with anyone 
  • go to school or any other childcare facility until 48 hours after the last episode of diarrhoea or vomiting
  • swim in swimming pools until 2 weeks after the diarrhoea has stopped

If your child is at nursery/school please inform them that your child has had D&V.

Feedback on this section

Select here for a PDF version of Coughs, Colds & Breathing Difficulties Pathway Guidance for Parents & Carers.
If you would like to print out  the Pathway information - please do so from this document.


What should I do if my child has a high temperature?

A normal temperature is less than 37.5◦C

Babies

  • 0-3 months: Temperature above 38⁰C – seek help
  • 3-6 months: Temperature above 39⁰C – seek help

Babies and children 6 months and older

A high temperature alone is not a good guide to working out how ill your baby or child is. For further information see the High Temperature pathway.

Please note that very small babies may have low temperatures which may be worrying.

My baby has a cold and is not feeding well

  • Offer smaller and more frequent feeds
  • If your baby is taking less than half their usual feed (over a 12 hour period) seek help
  • Repeated dry or damp nappies, dry lips or mouth, sunken eyes or fontanelle (soft spot on top of babies head) are signs of dehydration: seek urgent help
  • Saline nose drops before feeds may help clear the mucous in the nose these can be purchased from a pharmacy

Preventing respiratory illness

  • Children who live in a smoky atmosphere are more likely to suffer from illness such as coughs, colds and asthma.
  • Protect you and your family by avoiding smoking and smokey areas.
  • Contact your local NHS stop smoking service or your GP surgery/pharmacy for help to quit smoking.
  • Cough medicines are NOT recommended for children under the age of 6 years.
  • Breastfeeding can help prevent respiratory illness, so try to continue.
  • Encourage the whole family to eat a healthy balanced diet.
  • Encourage the whole family to wash their hands regularly to prevent colds spreading.
  • The majority of children do not require antibiotics.

Catch it – Bin it – Kill it

Emergency

Call 999 if your child show signs of a life threatening illness which may include:

  • Your child’s colour becoming extremely pale or blue or both
  • Your child becoming unresponsive or you are unable to rouse your child
  • Several long pauses in your baby or child’s breathing lasting 10 seconds
  • Your child is struggling to speak or drink because of breathing difficulties

It's common for babies and children to get a lot of coughs and colds

Parents and carers can usually manage babies and children at home with:

  • A blocked nose
  • Cough
  • Sneezing
  • Sore throat
  • Earache
  • Feeding a little less than usual
  • Occasional vomit after coughing
  • General aches and pains

When should I seek help?

  • Coughs lasting more than 3 weeks
  • Fast, or short shallow breathing
  • Noisy breathing 
  • Forced or strained breaths
  • Chest and neck muscles pulled in with each breath
  • Sucking in under the rib cage
  • Raised temperature: see Page C overleaf
  • Less wet nappies: see Page B overleaf
  • Breathing makes baby’s head bob
  • Breathing makes nostrils widen
  • Difficulty speaking or drinking
  • Vomiting frequently after coughing
  • Having less than half of usual feeds
  • Pale or mottled skin (blotchiness, with different shades and colours)
  • Very restless, or very agitated, or very sleepy

People I can turn to for help

  • Friends and Family
  • Health Visitors
  • GP
  • Pharmacists
  • Out of Hours doctor
  • 111
  • NHS Choices Website
  • Children’s community nursing team

If your child is seen by a hospital doctor or by the Emergency Department they will inform your GP surgery, health visitor or school nurse.

What the health professional will do

With you they will reach a clear understanding of your child’s needs by:

  • Listening to you and your child’s concerns
  • Taking the full history including previous episodes or patterns
  • Observing and assessing your child 

With you they will agree a plan. The plan will depend on:

  • If your child is less than 6 months old
  • If there are signs of an illness that needs treatment
  • The need for further assessment
  • If there is a long term condition. e.g. asthma

The most common outcome for children with coughs, colds and breathing difficulties is to get better at home.

The Plan

  • The plan will include:
  • Where to look after your child – most will stay at home
  • Advice on home care – including when to ask for help again
  • Expected length of illness and likely outcomes
  • If and when a review of your child is necessary

For some the plan will include advice on:

  • Further assessment or tests
  • A named key contact
  • Attending nursery and school
  • Long term conditions
  • Further helpful information

How will I know my child is better?

  • Breathing will be back to normal
  • Drinking, eating, weeing and sleeping will start to improve
  • The cough will start to reduce within 3 weeks
  • The temperature will be normal (37.5oC or less) within 5 days

Feedback on this section

Select here for a PDF version of Constipation Pathway Guidance for Parents & Carers (of children over 1 month of age).
If you would like to print out the Pathway information please do so from this document.


What is normal?

We are all different, having a poo; anything from 3 times a day to 3 times a week is ‘normal’.

It can be difficult or embarrassing for many children (and adults) to talk about going to the toilet, this chart is often used to help understand what the normal poo looks like! Types 3 and 4 are considered the ‘normal’; types 1 and 2 are typically associated with constipation and types 5 to 7 with diarrhoea.

You may find it useful to use this chart when you talk to your child about going to the toilet, as they may be able to point out what it looks like now, and over a period of time, see how it improves.

Fibre & Fluid

  • 6-8 glasses of water every day
  • Regular meals
  • You could gradually include more fibre at each meal and snack, for example:
    • Fruit and vegetables - try to have a variety and aim to eat 5 “me sized” servings every day
    • High fibre breakfast cereals – at breakfast time or as a snack e.g. porridge, high fibre cereals
    • Wholemeal, granary or high fibre white bread
    • Don’t forget the old favourite baked beans

For further ideas and further information visit www.nhs.uk and search “5 a day” and “change 4 life”.

Lifestyle & Routine

Don’t be afraid to talk to your child about going to the toilet - after all we all do it!

Routine – Make time for a toilet routine, the urge to poo occurs naturally after eating - get into the habit of going to the toilet 20-30 minutes after meals, exercise regular.

Don’t rush children who need to sit for a little longer.

Position - Be comfortable and relaxed - use a child  seat if necessary. Feet on floor, stool or a step and hands free. If your child needs some encouragement use a windmill or bubbles and keep these just for the toilet – they occupy the hands, act as a distraction and relax the muscles.

Exercise - Children should aim for a minimum of 60 active minutes every day, for ideas see www.nhs.uk/change4life

Is my child constipated?

It can be difficult for children of any age to tell someone they are constipated. The signs to look for are:

  • Less than 3 poos a week
  • Tummy ache/cramps
  • Pain or straining when passing poo
  • Passing dry hard poo
  • Avoiding the toilet
  • Not feeling the need to poo
  • Feeling that the poo is not finished
  • Sore bottom
  • Unpleasant smelling wind
  • Soiling or watery poo

People I can turn to for help

Friends and Family may be able to give advice.

The key professionals trained to help children with constipation are health visitors, school nurses and GP.

They all work together as the core team to look after children with constipation and are experts at helping families.

If a child is seen by an out of hours doctor, a hospital consultant or by the Accident and Emergency department they will always link you and your child back into the core team.

What the team will do

With you they will reach a clear understanding of your child’s needs by:

  • Listening to your concerns
  • Taking a history
  • Carrying out a physical examination

Following this they will agree a plan with you based on National Guidance (NICE)†. The plan will depend on:

  • If there are any underlying medical conditions*
  • If the poo is impacted (large, dry, hard poo which is stuck)
  • Other related issues

† NICE – National Institute of health and Clinical Excellence www.nice.org.uk

* The most common type of constipation is called idiopathic which means it has no underlying cause.

The Plan

For constipation - Life style advice and medication such as lactulose/senna is available from your pharmacy. Some children may require treatment for impaction*.

The plan must include:

  • Medicines
  • Diet, drink, and exercise
  • Toilet routine and behaviour

In cases where impaction is diagnosed paediatric macrogol** will be used but you may also be given other medication such as lactulose/senna.

You will always receive:

  • A copy of the Health Builders Advice leaflet incorporating your child’s plan; and
  • A copy of this constipation pathway

* Impaction is a large, dry, hard poo which is stuck

**Only available on prescription

Support

A member of the core team will be in regular contact. Contact will initially be every 2-3 weeks.

If your child is impacted a member of the team will see them within a week of treatment starting.

After 8 weeks if no progress has been made, advice may be sought from a clinician.

The clinician will provide advice through the core team. Typically a child only needs to see a specialist once.

The core team will keep you up to date and regularly review progress with you.

How will I know my child is better?

  • They will have a soft comfortable poo
  • They will be less likely to become constipated again
  • Remember if your child becomes constipated then do not hesitate to contact your core team

choose your Poo - diagram to illustrate the different types


health builders logo - 'for children, young people and families'

Health Builders, a movement to transform services for children's health

What is Health Builders?

Health Builders is the network through which commissioners and NHS trusts have agreed to work together to transform the delivery of services for children young people and their families.

Health Builders works through existing organisations to deliver improvements.

What does Health Builders do?

Health Builders has been asked to lead the design and delivery of pathways which will improve quality and deliver better outcomes.

The Health Builder Pathway approach is simple, it is an outcome focused tool which empowers patients and constantly reminds professionals of their core purpose.

The pathway speaks directly to children, young people and their parents, making it clear ‘their entitlement’ from NHS services. The pathway makes clear what children, young people and their families should experience if national (NICE) guidance is properly adhered to. In this way the pathway also holds professionals to account.


Information poster on reasons to vaccinate children from flu


are-you-kitted-out-for-summer - what's in your first aid kid - cartoon characterHoliday Health tips for parents and carers

Health bosses have issued some top tips for parents and carers across North Cumbria and the North East to keep the family safe and healthy during the school holidays. 

Summer is a time for flip flops, paddling pools and beaches, and fun in the sun, but the season can be blighted with minor health niggles. 

The NHS has compiled a list of common conditions and top tips to stay well this summer. See the box below...


1. Minor cuts, grazes and burns


Minor cuts need to be washed with clean water and stop the bleeding before applying a plaster or dressing. If you think the wound is infected or at risk of becoming infected, see your GP, particularly if it is a wound to the palm of the hand as infection can spread more quickly from here.

Burns should be put under cool or lukewarm water (never ice water) and remove any clothing or jewellery close to the burn. Do not remove anything that is stuck to it. Wrap it in clean cling film or a plastic bag to protect it.

If a burn is bigger than your hand, is deep, causes charred or white skin, causes blisters or is chemical or electrical, you should seek immediate medical attention.
 

2. Insect bites and stings


Apply antiseptic or something cool to the area. If the bite or sting is particularly painful, you can give a dose of (age-appropriate) paracetamol or ibuprofen.

If there’s signs of infection such as pus, swollen glands or flu like symptoms, or if you have signs of an allergy, such as redness or swelling that is spreading, you should seek assistance from your GP.

If they have difficulty breathing or swallowing, rapid or severe swelling to the face, mouth or throat; dizziness, fainting, nausea or vomiting you should call 999 or proceed straight to A&E.

 

3.  Bangs to the head


Sit the injured person down, keep them calm and apply a cold compress to the affected area (frozen peas in a tea towel can work well).

Keep an eye out for unconsciousness, repeated vomiting, fits or seizures, problems with senses such as double vision or hearing loss, blood or clear liquid coming from the ears or nose, and memory loss, as any of these may mean a more serious injury. If any of these occur, proceed straight to A&E.


4.  Hay fever


Your local pharmacy can help with antihistamine, nasal spray, eye drops – they’ll have everything you need to relieve the symptoms.


5.  Exercise and outdoors for mental and physical wellbeing

Very overweight children tend to grow up to be very overweight adults, which can lead to health problems such as type 2 diabetes, heart disease and certain cancers.

Being active outdoors is great for your physical health and fitness, and evidence shows that it can also improve your mental wellbeing.

Let your kids help decide what to do. Children are more likely to participate in something if they're involved in picking it.

NHS England’s Medical Director for Cumbria and the North East, Professor Chris Gray, said: “It can be worrying for young ones and their parents when children become ill or have a minor accident. In the summer months, there are more chances for children to get involved in minor scrapes or sporting injuries.

“However many illnesses and injuries - if not serious - can be sorted with over the counter medication, a bit of first aid knowledge or a trip to the local pharmacist for minor illnesses such as cuts and gashes; sprains and strains; sickness and diarrhoea, bites and stings; hay fever and short-term raised temperature.

“Health advice is available at any time on the NHS Choices website or from your local pharmacist. Your local pharmacist is trained in managing minor illnesses and using a pharmacy as the first point of call for advice helps to free up GP time for urgent appointments.

“In all cases, if you think your child is more seriously injured or ill, you should seek medical advice as soon as possible. Further advice can be sought from your GP surgery or by calling NHS 111. In an emergency, dial 999 for an ambulance.”

To find your nearest service and get further advice, visit: http://www.urgentoremergency.co.uk