Top tips from our Emergency Department

Crying – Don’t worry. This is normal with a baby trying to get your attention. Crying normally increases when your baby is around two weeks of age and peaks at about six to eight weeks. Comforting methods can help but if not, remember that's okay. This phase will pass and it’s okay to walk away if you have checked the baby is safe.

Never shake or hurt a baby. Speak to someone if you need support such as family, friends, Midwife, GP or Health Visitor. Also, ICON is a charity that has a lot of information about infant crying. https://iconcope.org

Fever – Use an underarm thermometer as ear and forehead thermometers are not reliable in small babies.

If your baby has a fever over 38 degrees centigrade, they need to be seen urgently by a healthcare professional as babies less than 3 months of age have weaker immune systems.

Feeding – Babies are pretty good at knowing how much milk they need and they won’t necessarily take the same amount at the same time each day (or night). If your baby is wetting her nappies and gaining weight, these are signs he/she is feeding well. Small, milky vomits (possets) after feeds are normal. Your Health Visitor or Midwife can give you advice over the phone, along with:

• National Breastfeeding Helpline – 0300 100 1212
• https://www.laleche.org.uk

Feeling overwhelmed – Your body goes through a lot of hormonal changes after giving birth and feelings of anxiety and being overwhelmed are common until your baby is about 10 days old. Signs and symptoms can include:

• Feeling emotional and irrational
• Bursting into tears for no apparent reason
• Feeling irritable or touchy
• Feeling depressed or anxious

These feelings should settle but if your symptoms aren’t improving after a couple of weeks, talk to your Health Visitor or GP.

Fever – A temperature over 38 degrees centigrade is a normal sign that your child is fighting an infection. Most of these are viral infections causing coughs, sore throats or sore ears - even with high temperatures in children less than five years old. It is also normal for toddlers to get six to eight infections a year.

Measuring temperature – Ear thermometers are inaccurate in children less than six months of age – it’s better to use an under-arm thermometer. Forehead thermometers are also not very reliable.

Treating fever – Ensure your child is taking plenty of fluids and you’re likely winning if they’re peeing. If your child is over three months, you can also keep them comfortable with Paracetamol (four to six hourly as instructed - maximum of four doses in 24 hours) and, if they’re peeing and don’t have kidney problems, Ibuprofen (six - eight hourly as instructed, maximum three doses in 24 hours). Always follow the dosing instructions on the bottle.

Hand hygiene is essential to help stop other household members from becoming infected.

Vaccination – The best protection against infection is routine immunisations. Your GP can still vaccinate your child during the Coronavirus pandemic.

Babies less than three months of age with fever – if your baby is less than three months old and has a fever over 38 degrees centigrade, they should be seen urgently by a healthcare professional, either your GP or at the Emergency Department. Their immune systems are still quite fragile so we would like to see and examine the child to ensure they don’t have a serious infection.

Coronavirus (COVID-19) - This new virus causes many symptoms in children which are similar to other common, self-limiting viral illnesses.

So far only a very few children have become seriously unwell with the virus and most young people get better on their own.

If your child has a continuous cough or fever or can’t smell anything, arrange for your child to get a coronavirus test and self-isolate until you know the result https://www.gov.uk/get-coronavirus-test

Sepsis - Luckily, sepsis in children is very rare. However, if your child has a seizure, their hands or feet feel cold or look mottled, they are very confused or lethargic or crying inconsolably – or you think something is not right - your child needs to come to the Emergency Department.

You should also seek advice via NHS 111 or your GP if you have a child over five years of age with a fever over 39 degrees C, severe tummy pain or if they have painful or more frequent wees.

Also, a rash that doesn’t go away when you press on it like this – the glass test - is also a reason to bring your child to the Emergency Department.

Symptoms – Most tummy bugs are caused by viruses and get better on their own. Gastroenteritis, as it’s called, usually starts with vomiting, followed by at least three watery, loose poos a day. Vomiting on its own can also be caused by other infections such as coughs and colds, earache and can be managed at home. As long as your child is drinking and peeing, you’re likely winning.

Vomiting and tummy pain which is worrying:

• If there is blood in the vomit – or the poo – or the vomit is a dark green colour, then you need to bring your child to the Emergency Department where we will see your child to make sure they don’t have a surgical problem (and if you can, please take a picture of the vomit or poo for us to see)
• Children with tummy bugs often have a bit of tummy pain but if your child can’t move because of the pain or is very weak and lethargic, bring them to the Emergency Department
• If your child is a boy with severe pain in his testicles, bring him to the Emergency Department (his testicles might be twisted which would need an operation).

Treatment – Give plenty of fluids, even if they’re vomiting especially after each loose stool. If your child is finding it difficult to take oral rehydration salts like Dioralyte, then try diluting apple juice – half juice, half water.

Don’t give pure juice or fizzy drinks as this can make your child’s symptoms worse.

Don’t use medications like Immodium as these can be dangerous in some children. Antibiotics won’t help the infection.

Dehydration – Most children stop vomiting after one to two days and the diarrhoea stops after five to seven days – but can last up to two weeks. If your child is very lethargic, their lips look cracked and dry, they have no tears, cold hands and feet or aren't peeing, you should take them to the Emergency Department for assessment.

Household and contacts – Make sure your child doesn’t share towels and that the whole family washes their hands regularly to prevent the spread of the infection. Your child should also stay away from school or nursery for at least 48 hours after the diarrhoea and vomiting have stopped.

Painful, swollen limb, unable to move it – Give paracetamol and bring your child to the Emergency Department. If the limb is numb or the bone is sticking out, you should bring your child immediately.

Grazes, superficial cuts – As long as your child can straighten and bend the affected arm/leg/finger/thumb, simply give paracetamol and give the area a gentle clean with lukewarm water.

Deep cut – If it’s bleeding, apply gentle pressure to help stop this with a clean cloth or dressing, give paracetamol and bring your child to the Emergency Department. It’s important that we see these injuries within 12 hours – longer than this and we won’t be able to close the wound because of the risk of infection.

Bumps to the head - As long as your child didn’t lose consciousness, they didn’t have a seizure and they haven’t vomited – and you’re happy that they’re back to their normal, happy self – you can watch them at home. But bring them in if they’re abnormally sleepy, they start vomiting or they’re an infant (less than 12 months of age) with a big bruise.

Burns - Expose your child’s burned area and treat with cool running water – a shower head is ideal for this. You should try and treat for 15-20 minutes. After you’ve done this, cover the burn in clingfilm if you have it – things like toothpaste don’t help.

Give some paracetamol for pain relief. Small burns less than the palm of your child’s hand that are red and look like mild sunburn can be treated at home with cooling and paracetamol. But if the burn is larger than this, blisters or looks pale and white, bring your child to the Emergency Department.

Cough – Often a sign of viral infection and doesn’t often affect the chest. If your child is taking fluids, peeing and is otherwise well, with no difficulty breathing (see video), this should settle on its own in two to three weeks.

Bronchiolitis – A viral chest infection in babies less than a year of age. Most babies get better by themselves but the infection can get worse around day 4.

If your baby is taking less than half her normal feeds or isn’t wetting her nappy, or if your baby’s chest and tummy are seesawing (moving abnormally in and out), they need to be seen by a doctor.

If your baby looks grey or blue or stops breathing, call 999 immediately.

Wheeze – Common in toddlers where a viral infection goes to their chest – the wheezy sound is caused by their airways tightening in response to the virus. If you think your child sounds wheezy, they need to be seen by a nurse practitioner or doctor to see if your child will get better with an inhaler. Most children can be managed at home after this. However, if your child is struggling to breathe, they need to come to the Emergency Department and if their face is grey or blue or they stop breathing, call 999 immediately.

This advice also applies if your child is asthmatic.

Croup – If your child makes a loud, barking cough like a seal, they likely have an infection called croup. The sound is caused by the virus causing swelling and narrowing to the upper airway. Bring your child to the Emergency Department where they will be given medicine to reduce the swelling.

COVID-19 (coronavirus) – This new virus causes many symptoms in children which are similar to other common viral illnesses. Most children get better on their own. To date, very few children have become seriously unwell with the virus.

If your child has a continuous cough or fever or can’t smell anything, arrange for your child to get a coronavirus test and self-isolate until you know the result https://www.gov.uk/get-coronavirus-test.