Sam Norman: Well, babies are much tougher, the most people think they still get it like everybody else. The only problem is that, we can’t always tell what’s wrong with them. Doctor Su Laurent is a Consultant Paediatrician at Barnet & Chase Farm Hospitals, and also the Baby Channels Medical Advisor. She is here to talk about common baby problems and conditions. Su, I was wondering, was it a comfort to you to the fact that you were a Paediatrician when you’re having your own babies?
Su Laurent: I think it was extremely comforting to know that babies have lots of little tiny problems and that in fact most of them are going to think things that really do matter, and the things that are going to get better by themselves.
Sam Norman: A negligible?
Su Laurent: Negligible. I think that for first time parents, I really recognize how anxious they feel about little things. They often ask me about little things that actually I can quickly dismiss as being quite normal.
Sam Norman: Were you very anxious for your first baby about little things, I mean--
Su Laurent: I don’t think I was, I think I was probably slightly too laid back in many ways. I remember my mother-in-law came to stay with me when I was living in America at the time and she was anxious about absolutely everything and I kept having to say, don’t worry, don’t forget that I am the paediatrician. This is normal.
Sam Norman: Now, people, I mean people -- I used to worry horribly with my first child and I think probably caused it too much in a way. But I mean sort of spots and rashes and stuff?
Su Laurent: I would say that every baby will get some sort of spots or some sort of rashes and there are a few that are very common. In the first few days, there is something, which sounds rather, which is a blanching red rash, which lots of babies get.
Sam Norman: Yeah.
Su Laurent: And it’s quite interesting because if you look at the spots and you would draw a little circle around the spot, and then come back a few hours later, you will find that, that spot had gone but another one had appeared somewhere else. They can be quite significant with the spot, but actually the babies finding themselves, there is nothing to worry about and that disappears in a few days.
Sam Norman: So, you don’t need to bother a doctor?
Su Laurent: You don’t have to. We often get always to have a look at this, on the neo-natal unit or on the postnatal, we often get to have a look and you can quickly dismiss that as being something quite normal.
Sam Norman: Because the natural reaction is, I mean as soon as your baby gets a spot or rashes, it sort of meningitis kind of looks, isn’t it? Looms out everybody.
Su Laurent: Exactly.
Sam Norman: So, I mean how can you sort of rationalize? What’s the differential diagnosis?
Su Laurent: Well, I would say, I mean there are all sorts of baby spots, which are very common, which are then sort of milk spots, they get that in their face, and they can get spots that even look a bit like acne as well, some people call it neo-natal acne, they are all normal. The sort of spots you need to be worried about are the sort of spots which maybe associated with the baby being irritable or unwell or having an abnormal cry, something which makes you think that this baby is not right, they’re not feeding properly, but the majority of normal baby spots are just a face that they’re going to go through.
Sam Norman: Again, I suppose it comes down to instinct, doesn’t it? I mean with a first baby you’re not really aware of how they ought to behave or what’s normal and what isn’t, but presumably mothers do have a pretty good instinct about --
Su Laurent: I am always reassuring mothers that with motherhood comes a mothering instinct, and in fact I’m always teaching junior doctors, it’s very important to listen to mothers because they will understand their babies more than anybody else.
Sam Norman: Yes, it’s almost a nature, isn’t it?
Su Laurent: It is. I think and just I would say to mothers, trust yourself, trust yourself. If you are really worried about your baby, then let us know, but if actually, you think the baby is okay, then you’re probably right.
Sam Norman: Talking about Jaundice. I was always encouraged to take the baby out, my -- both mine was slightly Jaundice and nothing to worry about but I was encouraged to take them out in the pram in the sunlight, if there was any?
Su Laurent: That’s absolutely right because in fact, it’s the sunlight, it’s the ultraviolet in the sunlight which helps get rid off the Jaundice and in fact that’s how it was discovered that the Jaundice babies on the side of the postnatal ward, which were by the window won’t really gets Jaundice as the ones on the other side of the ward.
Sam Norman: Really? That is as simple as that.
Su Laurent: Yeah, simple as that.
Sam Norman: The babies always vomiting on the I mean there is -- they get sort of stains all over into the first six months. When should that become a worry?
Su Laurent: Well, a little bit of what we call positing is completely normal. It’s only a worry, if -- we have two reasons that might be worried; one, if that the baby is just not gaining weight and other will see that is concerning, and the other thing is if a baby is in pain and quite often the baby has a condition, which we call reflux. What it means is that it is a significant amount of the contents of their stomach are coming up the soft passage over gullet and that causes his pain, and you may well see a baby who arches their back, who vomits quite a lot and those babies may need a little bit of treatment.
Sam Norman: Alright, okay, so a visit to the doctor, and then what’s the treatment?
Su Laurent: Well, very often the first thing is something called Gaviscon, which many mums are given in their pregnancy because they have the same sort of condition, which is --
Sam Norman: Heartburn, isn’t it?.
Su Laurent: Heartburn, that’s right. Gaviscon conserve two functions in babies, one of that can thicken their feet, so it makes it -- the feet stay down more, and the second thing is it’s an antacid, so it prevents the pain.
Sam Norman: How do you workout, whether you got a restless baby or particularly colicy baby, I mean I just have this --
Su Laurent: The word Colic and also the expression teething is used all the time.
Sam Norman: Exactly. My one of the other words.
Su Laurent: Exactly. Everytime you go to a miserable baby.
Sam Norman: Yeah.
Su Laurent: And it’s almost as very difficult to tell, it maybe just an age thing, so there are certain ages when colic is common; for example, colic is very common at about three months. But often, it’s the way they rive the round or where they seem to be in discomfort and there are millions of different remedies. The only thing that actually used to work for colic is something that contained alcohol, the old fashion grape water.
Sam Norman: Fantastic.
Su Laurent: But I always say to breast feeding mothers to have a good slug of wine in the evening and that’ll really help.
Sam Norman: I remember, as my grandmother was encouraging little bit of brandy in the milk or something.
Su Laurent: See there you go, there you go.
Sam Norman: Would that work? Would you recommend it?
Su Laurent: Yes, but it would. No, I call it on television and specially recommend it but it does work.
Sam Norman: Yes, and that helps them sleep, which is I guess what you desperately need I think.
Su Laurent: Yes.
Sam Norman: Now also the sticky eyes, that’s another thing isn’t it with babies and they always got sort of --
Su Laurent: They often get really dungy sticky eyes.
Sam Norman: Yeah.
Su Laurent: And usually if you can just clean the sticky stuff away in the morning with just some the cooled boiled water on a bit of cotton ball, that’s fine. If it looks infected, in other words, yellow or gungy, you need to -- or the baby’s eyes look red and you need to go to see your GP and get some eye drops, some antibiotic eye drops.
Sam Norman: Right.
Su Laurent: There are a few babies who will get persistently sticky eyes and sometimes that’s because of blocked tear ducts and that may, I mean visit your GP. And a very few, if it’s going until or about a year, we’ll need to have that tear ducks propped to clear them out.
Sam Norman: What percentages of babies do have significant health problems, along the sort of lines we’re discussing? How many just get take into the GP rather sort of too quickly?
Su Laurent: Well, I would say that first time babies get taken to the GP far more often than other babies.
Sam Norman: Yes.
Su Laurent: And that’s excuse me.
Sam Norman: I used to camp out.
Su Laurent: Oh, yes and that’s normal. I think that if you’re worried, you go and have a chat with GP. Very often I think the person to go and see is your Health Visitor because Health Visitor will know awful lot about normal baby issues and if Health Visitor is worried, she’ll ask the GP to have a look. So, ask your questions, but eventually you probably find that the majority of the mother, you will be reassured about and next babies, you’ll be much more relaxed.
Sam Norman: What about administering antibiotics to babies? Under what circumstances, would you recommend those?
Su Laurent: Antibiotics, very, very contentious I would say and on the whole we give far – well, we used to give far too many antibiotics. I think we’ve got it much more in proportion now, and antibiotics are strictly was treating bacterial conditions.
Sam Norman: Right.
Su Laurent: There is a big difference between that bacteria and viruses.
Sam Norman: If it’s a viral, yeah.
Su Laurent: Viruses are different sorts of organisms and they don’t get batted with antibiotics, and the vast majority of problems that babies will have will be viral.
Sam Norman: Right.
Su Laurent: And you’ll probably get quite fed up against your GP and being told it’s viral, but quite honestly usually it’s viral.
Sam Norman: Is there any sense in which, I mean I remember my first baby was always sick with a sort of ear, nose and throat infections. Is that something you want to explain as we sort of part of his immune system booting itself up, is there anyway in which it is actually quite good for babies to have all these things?
Su Laurent: There is quite a lot of interest in exposure to infections and whether or not you develop allergy when you’re older.
Sam Norman: Oh, I see.
Su Laurent: And there is this big theory around and I’ll call the hygiene theory in fact, and the theory is that if you get lots of exposure to infections in your immune system is doing what it’s made to do, which is to fight infections, it’s less likely to do what it’s not made to do, which is to develop allergies to things. In some people, I always comfort the parent whose children have got lots and lots of infections in their first year of life, by saying that actually, they’re probably less likely to develop allergies when they’re older.
Sam Norman: Oh, that’s encouraging.
Su Laurent: Yes.
Sam Norman: Because I mean, you know I had this kid, he was ill every three weeks with basically in terms of like that was – cool, yeah and this went on for about 18 months or so, I mean it was quite --
Su Laurent: It’s very worrying, isn’t it?
Sam Norman: It is incredibly worrying.
Su Laurent: When to give antibiotics and when not to give antibiotics and I think then you really need to rely in your GP, trust in your GP to have a good look at your child’s throat. Very often, it’s just going to be yet another virus, but sometimes it will need antibiotics for tonsillitis.
Sam Norman: Yeah, I am sure actually he was probably given too much antibiotic and it was mainly viral, but it is very interesting, which also brings you know to the high temperatures, which I mean a big danger in babies, the febrile convulsions. Can you describe what those are?
Su Laurent: Febrile convulsions are actually remarkably common and they are due to the over heating of the baby’s brain or a young child’s brain up to the age of five or six. Now, febrile convulsions can happen in any child, but there are some children most susceptible and it tends to run in families and you’ll often find that if the parent has had febrile convulsions, the child is more likely to.
Sam Norman: And is it -- what is it? Is it sort of one of the brain causing?
Su Laurent: It’s in excessively high temperature, which then causes the child to have a fit.
Sam Norman: Right.
Su Laurent: In other words, to have a period of unconsciousness of shaking, it’s terrifying for the parents to watch, absolutely terrifying, but it isn’t harming the baby and not all the child, that is the important thing to understand.
Sam Norman: It’s not a precaster to epilepsy?
Su Laurent: It’s not a precaster to epilepsy. A very, very small percentage of children who have febrile convulsions will have epilepsy, but they probably would have had epilepsy anyway.
Sam Norman: Right.
Su Laurent: So it’s not -- it doesn’t cause epilepsy and we don’t call it epilepsy when we see a child. In babies, specifically under the age of six months, we wouldn’t call it a febrile convulsion, we look very, very hard for a course for it rather than calling it febrile convulsion, but six months onwards, we would then start to say, this may or may not be a febrile convulsion.
Sam Norman: Alright. If the febrile convulsion, I mean I was imagining that they were dangerous because they could lead to some sort of brain damage, if the temperature wasn’t brought down. Is that right?
Su Laurent: Well, what can happen is, if a febrile convulsion goes on for a long period of time, by that I mean over 20 minutes, the baby can have reduction of oxygen supply to the brain.
Sam Norman: Right.
Su Laurent: But remarkably, in all the children I’ve seen over the 20 years plus I’ve been doing Paediatrics, even if they had febrile convulsions lasting for an hour or two, they had no long-term damage at all to their brains.
Sam Norman: Really?
Su Laurent: The other important thing is that a vast majority of them last 30 seconds or a minute or two minutes.
Sam Norman: So, if your child has one, what do you --
Su Laurent: Yes, say 999. It’s a very simple thing to say, you say 999 and ambulance will arrive very quickly, but the vast majority of the convulsions are stopped by the time the ambulance arrive. Put them somewhere, where they can’t harm themselves, and put them ideally on the floor and on there side and what we call the recovery position. Do not stick your finger in their mouth --
Sam Norman: If they have teeth.
Su Laurent: Very important, if they have teeth. People always worry that they’re going to choke on their tongue. They will not choke on their tongue, they will however bite your finger and you can have some very nasty injuries in them, children’s fingers, but parents unwittingly putting the fingers in the mouth. So, don’t do that. Try and keep them cool, so take off their clothing, don’t wrap them up, a lot of people when their child has a temperature, think they should be wrapped up. And do the reverse, strip them off, keep them cool. If a child is known to have febrile convulsions and you see they’re developing a temperature, try and get them calpol or paracetamol before hand, strumming the temperature down, strip them off, keep them cool.
Sam Norman: Cool bath?
Su Laurent: Yes, a cool or tepid bath, you don’t want to get your child to shiver.
Sam Norman: No.
Su Laurent: The shivering ironically can push temperature back up again. So, you have to cool them down.
Sam Norman: Oh, how interesting. How does you do that?
Su Laurent: When it that sort of making the body kind of work harder.
Sam Norman: Yeah.
Su Laurent: So you want and also turn comfortable for your child to be shivering.
Sam Norman: So there is a range of temperature?
Su Laurent: Exactly. The tepid bath or tepid sponging cools the little things.
Sam Norman: Su, thank you very, very much. That was very informative. Thank you.