Children’s 0-19 Services

Before you take any supplements talk to your GP, midwife or health visitor to make sure they are appropriate for you.

A healthy diet will give you most of the nutrition you need, but folic acid and vitamin D are also important to take.

Tommy’s has clear information about supplements including folic acid, vitamin D and iron, which you can access this by clicking here.

The National Institute for Health and Care Excellence or NICE has information on their website about national guidance on supplements including folic acid, vitamin D, vitamin A, other supplements and food hygiene. You can access this by clicking here.

You can also watch the NHS video about taking supplements here.

Antenatal very simply means before birth – or pregnancy.

During your pregnancy you will receive antenatal care which might be called pregnancy care or maternity care. The first step to access this care is to tell your GP or midwife that you are pregnant.

If you are expecting your first child, you will have up to 10 antenatal appointments.
If you’ve had a baby before you will have around seven appointments dependent on your situation.

You can find out the schedule for antenatal appointments that you are likely to have by clicking here.

More information can be found on the NHS – Your Antenatal Care website – please click here to access this website.

During your pregnancy you will be offered screening appointments which are either blood tests, ultrasounds or a mix of both. 

The video below gives more information on screening information:

You can also view the Public Health England (PHE) Screening tests for you and your baby leaflet by clicking here for more information.

WHEN WILL I MEET MY HEALTH VISITOR?

During your second trimester (week 13 to week 28 of pregnancy) you will be contacted by one of our health visitors from the NHFT Children’s 0-19 team.

The purpose of this visit is to get to know you a little and to help us understand if there is anything we can help you with before your little one arrives. You don’t need to contact us to arrange your home visit, we will contact you.

If you are under 18 years of age and pregnant you may be eligible for our Family Nurse Partnership Programme (FNP). Ask your midwife for more details and a referral or contact FNP Northamptonshire on 01604 658830 or Northamptonshire.fnp@nhs.net.

For further information on Family Nurse Partnership please visit www.fnp.nhs.uk

When you are pregnant and during your appointments with healthcare professionals it is likely you will be asked, more than once, about domestic abuse.

Domestic abuse can come in many forms, and for some women it may start whilst they are pregnant.

No matter the cause, if you have found yourself in a situation where you are being emotionally, financially, psychologically or physically abused speaking up to your healthcare professional is important.

You will be asked about domestic abuse in a confidential and safe environment and this information won’t be shared with other services without your permission, unless there is concerns that you, your unborn child or any other children in your family might be at risk of serious harm.

There are support organisations both locally and nationally who are on hand to support you:

• Northamptonshire Against Domestic and Sexual Health 
   
• Refuge
  Refuge offers a free 24 hour national domestic abuse helpline – you can call them 0808 2000 247
   
• Women’s Aid offers online support and information which you can access by visiting their website
   
• Ring 999 – If you are in immediate danger call the police without delay.

During your pregnancy you might find that you don’t feel like yourself and this could be for many different reasons.

In this section we list a few commonly searched topics and provide some information for you too, however if you aren’t feeling well or you notice any changes please talk to your GP, midwife or health visitor to explore this further.

You will find information about:

• Bleeding in pregnancy
• Gestational diabetes
• Infections
• Pre-eclampsia

Where can I go for support?

It is important to access help when you need it. If you are concerned about anything please talk to your GP, midwife or your health visitor.

You can also call NHS 111 to talk through any potential symptoms or changes that you are feeling.

Call 999 in a medical emergency.

During your pregnancy you are likely to experience a wide range of symptoms such as morning sickness, haemorrhoids or piles, and many changes to your body.

Here we’ve put together some information to help.

Remember: if you have any concerns, worries or just want some advice you should talk to your healthcare professional such as your GP, midwife or health visitor.

The following are some of the things you could experience during your pregnancy, the NHS website has helpful information and tips about how you can manage these symptoms and when you should get help.

• Morning Sickness and nausea – click here for more information
   
• Haemorrhoids or piles – click here for more information
   
• Leaking nipples – click here for more information
   
• Deep vein thrombosis (DVT) – click here for more information
   
• Pelvic pain – click here for more information
   
• Indigestion and heartburn – click here for more information
   
• Tiredness and sleeping safely – click here for more information
   
• You can find out about more common pregnancy symptoms by accessing the NHS common health problems webpage which you can get to by clicking here.

Reflux can be very common and normally goes away as babies get older.

Reflux is when a baby vomits or brings up their milk, during or shortly after feeding.

NHS England's Reflux information

Start4Life's Reflux information

NCT's Reflux information

Behaviour is a form of communication expressing how your child is feeling.

Normal behaviours for your baby may include the following:

• periods of being quiet and alert
• periods of being unsettled
• it is normal for your baby to cry.

It is important to note that these are all forms of communication.

Below are some behaviour tips using the five to thrive model:

RESPOND

• When your baby looks ready, hold them facing you and wait to see if they make eye contact.
   
• Your baby will needs lots of time to respond, so pause and wait until they are ready to engage
   
• Your baby may look away because too much interaction can be very intense for them. Wait for your baby to come back in their own time
   
• A feed - look for ‘feeding cues’ like lip smacking, sucking and ‘rooting’ (turning their head and opening their mouths - rooting is a reflex action in small babies and happens automatically if you stroke their cheek)

CUDDLE

In the unsettled state your baby may fuss, whine, arch their backs, wriggle and be more sensitive to light and noise. Sometimes your baby may show they are over stimulated through physical signs such as hiccupping, yawning, sneezing, squirming, throwing their head back or even bringing up some milk. Babies who put their hands up to their face are often tired

If your baby is in an unsettled state they may need a change of pace and might benefit from:

A cuddle, you can’t ‘spoil’ your baby, cuddles provide security and makes the world seem safe.

RELAX

In the crying state your baby will be active, often grimacing and crying intensely.

If your baby is in their crying state they may need calming. There may be special ways your baby likes to be soothed. For example:

• Do they like being held when you walk about?
• Do they enjoy soft singing?
• Do they like being close to you skin to skin?
• Do they have a favourite cuddling position?
• Do they like to suck on their fingers?
• Do they like gentle rocking in the pram?
• Do they like to have eye contact while you gently ask them what the matter is?

Sometimes babies like to be listened to in the same way as an older child who is upset.

PLAY

• Facial expressions build brain patterns for recognising feelings in self and others. As the adult follows the lead of the baby, and then alternates leading and following in copying facial expressions and accompanying gestures, this also develops turn-taking and the ability to take part in conversations.
   
• Tongue play (wiggling the tongue, blowing raspberries, and so on) builds brain patterns linking together tongue control, human communication and pleasure. This is pre-speech, making the baby more ready to develop speech and language.

TALK

• The very best activity for a young baby is looking at your face and listening to your voice.
   
• Try singing gently to your baby, then pausing and watching for their reaction, then singing some more (don’t worry if you can’t sing in tune - your baby will love hearing your voice and being close to you)
   
• Taking turns in interaction is really important for your baby’s development

When it comes to teething, all babies are different. But your baby will probably get their first tooth some time during their first year.

Find out how to spot when your baby is teething and what order your baby's teeth are likely to appear in by clicking the link below.

For more information on teething please click on the link here.

Accidents happen, and often they happen in such a short space of time that before you can blink something has gone wrong.

When it comes to baby’s it is important that you keep a close eye them.

Accidents can come in all different ways and types including:

·         Burns and scalds

·         Choking

·         Drowning

·         Falls

·         Strangulation

·         Suffocation

·         Accidental poisoning

The NHS website has some useful information and top tips to help you keep your child safe – you can access this information by clicking here.

If your child has an accident it is important to know what to do and when you need to seek medical advice, again the NHS website has a long list of information including where you can learn basic first aid on their website. Click here to read more.

Safety and pets

If you have a pet such as a dog you should prepare them for your newborn and get them used to having a little one around. The Dog’s Trust has put together information about being dog smart around babies and children which you can access here.

Sudden infant death syndrome (SIDS) is the sudden, unexpected and unexplained death of an apparently healthy baby. You might be more familiar with the term ‘cot death’ but we do try to avoid using that term where possible and instead refer to it as SIDS.

In the UK, more than 200 babies die suddenly and unexpectedly every year and tend to affect babies under the age of 6 months. This statistic may sound alarming, but SIDS is rare and the risk of your baby dying from it is low.

Infants born prematurely or with a low birthweight are at greater risk. SIDS also tends to be slightly more common in baby boys. SIDS usually occurs when a baby is asleep, although it can occasionally happen while they're awake.

We don’t know the exact cause of SIDS but it is though that a number of different factors can play a role in increasing the risk of a baby dying from SIDS. These factors can include environmental stresses such as smoking, getting tangled in bedding and breathing obstructions.

The Lullaby Trust have pulled together a handy guide to safer sleep which can help reduce the risk of SIDS. You can access a digital copy of this guide by clicking here.

It is also important that you recognise that car seats and long journeys should be avoided as they can raise the risk of SIDS in very young babies. Click here to visit The Lullaby Trust’s information on car seats and SIDS.

The NHS website has information on what you can do to reduce the risk of SIDS which you can access here.

Basis has information about SIDS and safety and includes information on how you can reduce the risk of Sudden Infant Death Syndrome which can be accessed here.

SEEKING MEDICAL ADVICE IF YOUR BABY IS UNWELL

• Babies often have minor illnesses that you do not need to worry about. Give your baby plenty of fluids to drink and do not let them get too hot.
   
• If you're worried about your baby at any point, see your GP or call NHS 111 for advice.

Keeping your baby out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your baby’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However looking after your baby’s will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Things to know about sun safety:

Keeping your baby safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns and dehydration can occur and could cause some serious issues for your child.

Here are some tips you can use to help with sun safety:

• If your baby is under 6 months old they should be kept away from strong direct sunlight that might come through windows or if you are outside.
   
• If your baby’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.
   
• If you are taking your baby out in their pram do not cover their prams with any type of material as this can be very dangerous. When a pram is covered it prevents the vital movement of air around your baby so that the air they breathe out is the same air they breathe in. Without this movement of air, the recirculated air they will be breathing in will have a high percentage of carbon dioxide instead of oxygen, leaving your baby with less oxygen and potentially causing them to stop breathing all together.

What should I do if i think there is a problem?

If you have any questions or would like some more information regarding sun safety and your baby you can ask your midwife / health visitor or GP for advice.

For more information please visit NHS England website. 

Keeping your baby out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your baby’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However, looking after your baby’s will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Things to know about sun safety:

Keeping your baby safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns, and dehydration can occur and could cause some serious issues for your child.

Here are some tips you can use to help with sun safety:

• If your baby is under 6 months old, they should be kept away from strong direct sunlight that might come through windows or if you are outside.
   
• If your baby’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.
   
• If you are taking your baby out in their pram do not cover their prams with any type of material as this can be very dangerous. When a pram is covered it prevents the vital movement of air around your baby so that the air they breathe out is the same air they breathe in. Without this movement of air, the recirculated air they will be breathing in will have a high percentage of carbon dioxide instead of oxygen, leaving your baby with less oxygen and potentially causing them to stop breathing all together.

Here are some links to other places of information:

• NCT’s website has a sun safety for kids section which can be accessed here
   
• The Skin Cancer Foundation has written an article about sun-safe babies which can be accessed here.
   
• The Baby Centre explores how you can keep the sun off your baby which you can access here.
   
• Find out how you can keep your baby safe in hot weather by visiting the NHS’s webpage on it.

Dial 999 for an ambulance if your baby:

• stops breathing or turns blue
   
• is struggling for breath
   
• is unconscious or seems unaware of what's going on
   
• will not wake up
   
• has a fit for the first time, even if they seem to recover.

Sleep is an amazing brain journey, we spend about a third of our life asleep. While each person is unique, sleep follows a fairly predictable pattern that changes through life.  We experience both deep and lighter sleep and even have brief awakenings during the night which are all part of ‘normal sleep’. 

The benefits of sleep include

• Promotes growth
   
• Strengthens our immunity
   
• Helps our bodies repair
   
• Consolidates our  memory and learning
   
• Maintains our physical and emotional health

Lack of sleep effects our general wellbeing

• Impacts on our emotional wellbeing and mood
   
• Physical health and coordination
   
• Our ability to learn new information and problem solve

As a newborn grows they need different amounts of sleep.

This information has been taken from the NHS England website which you can access by clicking here.

If you are struggling to get your baby to sleep or for them to stay asleep please do talk to your health visitor, midwife or GP.

For a baby it is important you teach them that there is a difference between day and night. Even though they can’t understand words but creating a routine you can help them understand this difference.

During the day make sure the curtains are open, and they are stimulated with sensory play and when it comes to getting them to sleep, dim the lights and try to block out sounds that might disturb their sleep.

The NHS website has a sleep guide for babies which you can access by clicking here.

Although sleep routines will vary from family to family depending on your circumstances, the key is to try to make sure you keep the same approach each day where you can. Good sleep routines that are put in place now can help to build the foundations for positive sleep experiences later.

The Lullaby Trust has a useful website with tips, hints and information about how to improve sleep quality which you can access by clicking here.

You can watch The Lullaby Trust’s video on what bedding your baby needs below:

The team at The Lullaby Trust also have a range of sleep videos including how to monitor your baby’s temperature and co-sleeping information – you can access their YouTube channel by clicking here.

What can you do if your baby doesn’t want to sleep?

Keeping babies safe, both day and night while they are sleeping is important. The points to remember are:

• Always place your baby on their back to sleep
   
• Keep your baby smoke free, both before and after birth
   
• Give your baby a clear safe sleep space in the same room as you
   
•  Use a firm, flat, waterproof mattress in good condition 
   
• Breastfeed your baby if you can - Any breastfeeding is shown to lower the risk of Sudden Infant Death Syndrome/cot death
   
• Never sleep in a chair or sofa with your baby
   
• Never put your baby in bed with you if you have drunk alcohol, taken any kind of drugs, if your baby was born prematurely or of low birth weight
   
• Don’t let your baby get too hot, or cover their head or face. Babies don’t need hats indoors.
   
• Keep the sleep area free of pillows, duvets, loose bedding, toys, cot bumpers, sleep positioners, pods or nests

For more information on this important topic follow the links below:

Unicef's Caring for your Baby at Night is a great information website to give you more advice and information on safe sleeping. You can access this information by clicking here.

The Lullaby Trust have a very useful website to give your more information on safe sleeping. You can access the website by clicking here.

The contents of your baby’s nappy will change day to day. Nappy hygiene is really important and changing your baby when they have soiled their nappy will help prevent nappy rash and keep your newborn baby comfortable.

You can expect to change a baby between the ages of 0 months to 1 years old anywhere from 5 to 12 times a day.

Let’s talk baby poo

Newborn babies will pass dark sticky stools (poo) which are called meconium. These are black and tar-like and contain bile and other substances your baby swallowed whilst they were in the womb.

By day three (3) this poo should become lighter, runnier and much easier to clean up. From day four (4) and then for the first few weeks your baby should pass at least two (2) yellow stools each day.

The colour of baby poo varies when children are newborn and how fast they get to the ‘yellow poo’ stage is unique to each baby. Some children can get to the ‘yellow poo’ stage sooner than days five (5) or six (6) and that it okay. This can mean your baby is feeding very effectively and is probably taking in more milk.

Pampers have created a chart which shows the shades of poo and is rough guide to what you might expect. You can access this and more information from Pampers by clicking here.

For a more visual guide on what poo you might expect your baby to have you can visit the NCT website by clicking here.

It is common for babies to grunt and strain or even cry when they are having a poo and this doesn’t necessarily mean they are suffering with constipation.

Let’s talk baby wee

It can be very difficult to judge how often your baby passes urine as disposable nappies are efficient at absorbing the fluid. However, this will become easier to judge as you get used to the feel or weight of your baby’s nappies.

You should expect six (6) to eight (8) wet nappies a day in the early weeks but this can vary from baby to baby. If you are concerned about how much milk your baby is having you can be reassured by a heavy (wet) nappy that they are producing plenty of wee so are having plenty to drink.

Healthy urine is a pale colour and should not smell strong. If you notice darker urine or a strong smell speak to your health visiting team for advice.

How often should my baby do a poo?

Babies do an average of 4 poos a day in the first week of life. This goes down to an average of 2 a day by the time they're 1 year old.

Newborn babies who are breastfed may poo at each feed in the early weeks, then, after about 6 weeks, not have a poo for several days.

Formula-fed babies may poo up to 5 times a day when newborn, but after a few months this can go down to once a day.

It's also normal for babies to strain or even cry when doing a poo.

Your baby isn't constipated if their poos are soft, even if they haven't done one for a few days.

Is it normal for my baby's poo to change?

From day to day or week to week, your baby's poos will probably vary.

If you notice a definite change of any kind, such as the poos becoming very smelly, very watery or harder (particularly if there's blood in them), you should talk to your doctor or health visitor.

What should my baby’s poo look like?

Pampers have created a chart which shows the shades of poo and is rough guide to what you might expect. You can access this and more information from Pampers by clicking here.

For a more visual guide on what poo you might expect your baby to have you can visit the NCT website by clicking here.

My baby makes noises when the have a bowel movement is that normal?

Yes. It is common for babies to grunt and strain or even cry when they are having a poo and this doesn’t necessarily mean they are suffering with constipation.

How do I change a nappy?

Other things to know

In girls you might find they have false menstruation or pseudo menstruation which is harmless. It is a very light bleed from the vagina and comes from the effects of your own hormones on her system and will soon stop. If you are concerned please talk to your doctor or health visitor.

If you notice your baby’s wee is a darker urine or has a strong smell do as your health visiting team for advice.

Are there any other links that I should visit for more information?

The NHS website has some useful information about babies and their nappies which you can access by clicking here.

Reflux can be very common and normally goes away as babies get older.

Reflux is when a baby vomits or brings up their milk, during or shortly after feeding.

NHS England's Reflux information

Start4Life's Reflux information

NCT's Reflux information

Behaviour is a form of communication expressing how your child is feeling.

Normal behaviours for your baby may include the following:

• periods of being quiet and alert
• periods of being unsettled
• it is normal for your baby to cry.

It is important to note that these are all forms of communication.

Below are some behaviour tips using the five to thrive model:

RESPOND

• When your baby looks ready, hold them facing you and wait to see if they make eye contact.
   
• Your baby will needs lots of time to respond, so pause and wait until they are ready to engage
   
• Your baby may look away because too much interaction can be very intense for them. Wait for your baby to come back in their own time
   
• A feed - look for ‘feeding cues’ like lip smacking, sucking and ‘rooting’ (turning their head and opening their mouths - rooting is a reflex action in small babies and happens automatically if you stroke their cheek)

CUDDLE

In the unsettled state your baby may fuss, whine, arch their backs, wriggle and be more sensitive to light and noise. Sometimes your baby may show they are over stimulated through physical signs such as hiccupping, yawning, sneezing, squirming, throwing their head back or even bringing up some milk. Babies who put their hands up to their face are often tired

If your baby is in an unsettled state they may need a change of pace and might benefit from:

A cuddle, you can’t ‘spoil’ your baby, cuddles provide security and makes the world seem safe.

RELAX

In the crying state your baby will be active, often grimacing and crying intensely.

If your baby is in their crying state they may need calming. There may be special ways your baby likes to be soothed. For example:

• Do they like being held when you walk about?
• Do they enjoy soft singing?
• Do they like being close to you skin to skin?
• Do they have a favourite cuddling position?
• Do they like to suck on their fingers?
• Do they like gentle rocking in the pram?
• Do they like to have eye contact while you gently ask them what the matter is?

Sometimes babies like to be listened to in the same way as an older child who is upset.

PLAY

• Facial expressions build brain patterns for recognising feelings in self and others. As the adult follows the lead of the baby, and then alternates leading and following in copying facial expressions and accompanying gestures, this also develops turn-taking and the ability to take part in conversations.
   
• Tongue play (wiggling the tongue, blowing raspberries, and so on) builds brain patterns linking together tongue control, human communication and pleasure. This is pre-speech, making the baby more ready to develop speech and language.

TALK

• The very best activity for a young baby is looking at your face and listening to your voice.
   
• Try singing gently to your baby, then pausing and watching for their reaction, then singing some more (don’t worry if you can’t sing in tune - your baby will love hearing your voice and being close to you)
   
• Taking turns in interaction is really important for your baby’s development

When it comes to teething, all babies are different. But your baby will probably get their first tooth some time during their first year.

Find out how to spot when your baby is teething and what order your baby's teeth are likely to appear in by clicking the link below.

For more information on teething please click on the link here.

Accidents happen, and often they happen in such a short space of time that before you can blink something has gone wrong.

When it comes to baby’s it is important that you keep a close eye them.

Accidents can come in all different ways and types including:

·         Burns and scalds

·         Choking

·         Drowning

·         Falls

·         Strangulation

·         Suffocation

·         Accidental poisoning

The NHS website has some useful information and top tips to help you keep your child safe – you can access this information by clicking here.

If your child has an accident it is important to know what to do and when you need to seek medical advice, again the NHS website has a long list of information including where you can learn basic first aid on their website. Click here to read more.

Safety and pets

If you have a pet such as a dog you should prepare them for your newborn and get them used to having a little one around. The Dog’s Trust has put together information about being dog smart around babies and children which you can access here.

Keeping your baby out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your baby’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However looking after your baby’s will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Things to know about sun safety:

Keeping your baby safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns and dehydration can occur and could cause some serious issues for your child.

Here are some tips you can use to help with sun safety:

• If your baby is under 6 months old they should be kept away from strong direct sunlight that might come through windows or if you are outside.
   
• If your baby’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.
   
• If you are taking your baby out in their pram do not cover their prams with any type of material as this can be very dangerous. When a pram is covered it prevents the vital movement of air around your baby so that the air they breathe out is the same air they breathe in. Without this movement of air, the recirculated air they will be breathing in will have a high percentage of carbon dioxide instead of oxygen, leaving your baby with less oxygen and potentially causing them to stop breathing all together.

What should I do if i think there is a problem?

If you have any questions or would like some more information regarding sun safety and your baby you can ask your midwife / health visitor or GP for advice.

For more information please visit NHS England website. 

Keeping your baby out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your baby’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However, looking after your baby’s will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Things to know about sun safety:

Keeping your baby safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns, and dehydration can occur and could cause some serious issues for your child.

Here are some tips you can use to help with sun safety:

• If your baby is under 6 months old, they should be kept away from strong direct sunlight that might come through windows or if you are outside.
   
• If your baby’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.
   
• If you are taking your baby out in their pram do not cover their prams with any type of material as this can be very dangerous. When a pram is covered it prevents the vital movement of air around your baby so that the air they breathe out is the same air they breathe in. Without this movement of air, the recirculated air they will be breathing in will have a high percentage of carbon dioxide instead of oxygen, leaving your baby with less oxygen and potentially causing them to stop breathing all together.

Here are some links to other places of information:

• NCT’s website has a sun safety for kids section which can be accessed here
   
• The Skin Cancer Foundation has written an article about sun-safe babies which can be accessed here.
   
• The Baby Centre explores how you can keep the sun off your baby which you can access here.
   
• Find out how you can keep your baby safe in hot weather by visiting the NHS’s webpage on it.

Dial 999 for an ambulance if your baby:

• stops breathing or turns blue
   
• is struggling for breath
   
• is unconscious or seems unaware of what's going on
   
• will not wake up
   
• has a fit for the first time, even if they seem to recover.

Sleep is an amazing brain journey, we spend about a third of our life asleep. While each person is unique, sleep follows a fairly predictable pattern that changes through life.  We experience both deep and lighter sleep and even have brief awakenings during the night which are all part of ‘normal sleep’. 

The benefits of sleep include

• Promotes growth
   
• Strengthens our immunity
   
• Helps our bodies repair
   
• Consolidates our  memory and learning
   
• Maintains our physical and emotional health

Lack of sleep effects our general wellbeing

• Impacts on our emotional wellbeing and mood
   
• Physical health and coordination
   
• Our ability to learn new information and problem solve

Babies around 1 years old need approximately 11 hours sleep during the night and 2 hours 30 minutes during the day.

This information has been taken from the NHS England website which you can access by clicking here.

If you are struggling to get your baby to sleep or for them to stay asleep please do talk to your health visitor, midwife or GP.

For a baby it is important you teach them that there is a difference between day and night. Even though they can’t understand words but creating a routine you can help them understand this difference.

During the day make sure the curtains are open, and they are stimulated with sensory play and when it comes to getting them to sleep, dim the lights and try to block out sounds that might disturb their sleep.

The NHS website has a sleep guide for babies which you can access by clicking here.

Although sleep routines will vary from family to family depending on your circumstances, the key is to try to make sure you keep the same approach each day where you can. Good sleep routines that are put in place now can help to build the foundations for positive sleep experiences later.

The Lullaby Trust has a useful website with tips, hints and information about how to improve sleep quality which you can access by clicking here.

You can watch The Lullaby Trust’s video on what bedding your baby needs below:

The team at The Lullaby Trust also have a range of sleep videos including how to monitor your baby’s temperature and co-sleeping information – you can access their YouTube channel by clicking here.

What can you do if your baby doesn’t want to sleep?

Keeping babies safe, both day and night while they are sleeping is important. The points to remember are:

• Always place your baby on their back to sleep
   
• Keep your baby smoke free, both before and after birth
   
• Give your baby a clear safe sleep space in the same room as you
   
•  Use a firm, flat, waterproof mattress in good condition 
   
• Breastfeed your baby if you can - Any breastfeeding is shown to lower the risk of Sudden Infant Death Syndrome/cot death
   
• Never sleep in a chair or sofa with your baby
   
• Never put your baby in bed with you if you have drunk alcohol, taken any kind of drugs, if your baby was born prematurely or of low birth weight
   
• Don’t let your baby get too hot, or cover their head or face. Babies don’t need hats indoors.
   
• Keep the sleep area free of pillows, duvets, loose bedding, toys, cot bumpers, sleep positioners, pods or nests

For more information on this important topic follow the links below:

Unicef's Caring for your Baby at Night is a great information website to give you more advice and information on safe sleeping. You can access this information by clicking here.

The Lullaby Trust have a very useful website to give your more information on safe sleeping. You can access the website by clicking here.

Pampers have created a chart which shows the shades of poo and is rough guide to what you might expect. You can access this and more information from Pampers by clicking here.

For a more visual guide on what poo you might expect your baby to have you can visit the NCT website by clicking here.

It is common for babies to grunt and strain or even cry when they are having a poo and this doesn’t necessarily mean they are suffering with constipation.

Let’s talk baby wee

It can be very difficult to judge how often your baby passes urine as disposable nappies are efficient at absorbing the fluid. However, this will become easier to judge as you get used to the feel or weight of your baby’s nappies.

Healthy urine is a pale colour and should not smell strong. If you notice darker urine or a strong smell speak to your health visiting team for advice.

Diarrhoea

Look out for a sudden change in frequency of watery poo. A foul smelling dirty nappy and a baby with signs of a fever could suggest an intestinal infection.  Significant diarrhoea can lead to your baby being dehydrated so it is important to encourage them to drink. Small, frequent drinks are best if your baby is feeling unwell. Seek medical advice from your doctor or health visitor if your baby is suffering from diarrhoea.

Information about diarrhoea can be found here

Constipation

A sign of constipation is hard and pebble like stools. Constipation is more common among formula fed babies – here are a few tips if your baby is suffering from constipation.

• A simple way to manage constipation initially is to give your baby small amounts of cooled boiled water (30 – 40 mls). If you find that giving your baby extra water still doesn’t work please contact your health visiting team for advice.
• Don’t give prune juice – it contains a natural bowel irritant and is not suitable for babies under nine months of age, even when diluted. Don’t give orange juice before six months of age.
• Don’t add any form of sugar, malt extract or rice cereal to formula – this will not help constipation and can cause a choking risk.
• Don’t introduce solids before six months of age – this is not recommended.

When you start to introduce solids to your babies (around 6 months old) this also changes the look and smell of their poo. Introducing solid food produces a darker brown poo which smells more than when just on milk feeds.

Information on constipation here. 

Behaviour is a form of communication expressing how your child is feeling.

Normal behaviours for your baby may include the following:

• periods of being quiet and alert
• periods of being unsettled
• it is normal for your baby to cry.

It is important to note that these are all forms of communication.

Below are some behaviour tips using the five to thrive model:

RESPOND

• When your baby looks ready, hold them facing you and wait to see if they make eye contact.
   
• Your baby will needs lots of time to respond, so pause and wait until they are ready to engage
   
• Your baby may look away because too much interaction can be very intense for them. Wait for your baby to come back in their own time
   
• A feed - look for ‘feeding cues’ like lip smacking, sucking and ‘rooting’ (turning their head and opening their mouths - rooting is a reflex action in small babies and happens automatically if you stroke their cheek)

CUDDLE

In the unsettled state your baby may fuss, whine, arch their backs, wriggle and be more sensitive to light and noise. Sometimes your baby may show they are over stimulated through physical signs such as hiccupping, yawning, sneezing, squirming, throwing their head back or even bringing up some milk. Babies who put their hands up to their face are often tired

If your baby is in an unsettled state they may need a change of pace and might benefit from:

A cuddle, you can’t ‘spoil’ your baby, cuddles provide security and makes the world seem safe.

RELAX

In the crying state your baby will be active, often grimacing and crying intensely.

If your baby is in their crying state they may need calming. There may be special ways your baby likes to be soothed. For example:

• Do they like being held when you walk about?
• Do they enjoy soft singing?
• Do they like being close to you skin to skin?
• Do they have a favourite cuddling position?
• Do they like to suck on their fingers?
• Do they like gentle rocking in the pram?
• Do they like to have eye contact while you gently ask them what the matter is?

Sometimes babies like to be listened to in the same way as an older child who is upset.

PLAY

• Facial expressions build brain patterns for recognising feelings in self and others. As the adult follows the lead of the baby, and then alternates leading and following in copying facial expressions and accompanying gestures, this also develops turn-taking and the ability to take part in conversations.
   
• Tongue play (wiggling the tongue, blowing raspberries, and so on) builds brain patterns linking together tongue control, human communication and pleasure. This is pre-speech, making the baby more ready to develop speech and language.

TALK

• The very best activity for a young baby is looking at your face and listening to your voice.
   
• Try singing gently to your baby, then pausing and watching for their reaction, then singing some more (don’t worry if you can’t sing in tune - your baby will love hearing your voice and being close to you)
   
• Taking turns in interaction is really important for your baby’s development

Accidents happen, and often they happen in such a short space of time that before you can blink something has gone wrong.

When it comes to babies it is important that you keep a close eye them.

Accidents can come in all different ways and types including:

·         Burns and scalds

·         Choking

·         Drowning

·         Falls

·         Strangulation

·         Suffocation

·         Accidental poisoning

The NHS website has some useful information and top tips to help you keep your child safe – you can access this information by clicking here.

If your child has an accident it is important to know what to do and when you need to seek medical advice, again the NHS website has a long list of information including where you can learn basic first aid on their website. Click here to read more.

Safety and pets

The Dog’s Trust has put together information about being dog smart around babies and children which you can access here.

Things to know about sun safety:

Keeping your baby safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns and dehydration can occur and could cause some serious issues for your child.

Here are some tips you can use to help with sun safety:

• If your baby’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.
• If you are taking your baby out in their pram do not cover their prams with any type of material as this can be very dangerous. When a pram is covered it prevents the vital movement of air around your baby so that the air they breathe out is the same air they breathe in. Without this movement of air, the recirculated air they will be breathing in will have a high percentage of carbon dioxide instead of oxygen, leaving your baby with less oxygen and potentially causing them to stop breathing all together.

What should I do if i think there is a problem?

If you have any questions or would like some more information regarding sun safety and your baby you can ask your midwife / health visitor or GP for advice.

For more information please visit NHS England website. 

Keeping your baby out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your baby’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However, looking after your baby’s will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Dial 999 for an ambulance if your baby:

• stops breathing or turns blue
• is struggling for breath
• is unconscious or seems unaware of what's going on
• will not wake up
• has a fit for the first time, even if they seem to recover.

Sleep is an amazing brain journey, we spend about a third of our life asleep. While each person is unique, sleep follows a fairly predictable pattern that changes through life.  We experience both deep and lighter sleep and even have brief awakenings during the night which are all part of ‘normal sleep’. 

The benefits of sleep include

• Promotes growth
   
• Strengthens our immunity
   
• Helps our bodies repair
   
• Consolidates our  memory and learning
   
• Maintains our physical and emotional health

Lack of sleep effects our general wellbeing

• Impacts on our emotional wellbeing and mood
   
• Physical health and coordination
   
• Our ability to learn new information and problem solve

This information has been taken from the NHS England website which you can access by clicking here.

If you are struggling to get your baby to sleep or for them to stay asleep please do talk to your health visitor, midwife or GP.

For a baby it is important you teach them that there is a difference between day and night. Even though they can’t understand words but creating a routine you can help them understand this difference.

During the day make sure the curtains are open, and they are stimulated with sensory play and when it comes to getting them to sleep, dim the lights and try to block out sounds that might disturb their sleep.

The NHS website has a sleep guide for babies which you can access by clicking here.

Although sleep routines will vary from family to family depending on your circumstances, the key is to try to make sure you keep the same approach each day where you can. Good sleep routines that are put in place now can help to build the foundations for positive sleep experiences later.

The Lullaby Trust has a useful website with tips, hints and information about how to improve sleep quality which you can access by clicking here.

You can watch The Lullaby Trust’s video on what bedding your baby needs below:

The team at The Lullaby Trust also have a range of sleep videos including how to monitor your baby’s temperature and co-sleeping information – you can access their YouTube channel by clicking here.

What can you do if your baby doesn’t want to sleep?

Keeping babies safe, both day and night while they are sleeping is important. The points to remember are:

• Always place your baby on their back to sleep
   
• Keep your baby smoke free, both before and after birth
   
• Give your baby a clear safe sleep space in the same room as you
   
•  Use a firm, flat, waterproof mattress in good condition 
   
• Breastfeed your baby if you can - Any breastfeeding is shown to lower the risk of Sudden Infant Death Syndrome/cot death
   
• Never sleep in a chair or sofa with your baby
   
• Never put your baby in bed with you if you have drunk alcohol, taken any kind of drugs, if your baby was born prematurely or of low birth weight
   
• Don’t let your baby get too hot, or cover their head or face. Babies don’t need hats indoors.
   
• Keep the sleep area free of pillows, duvets, loose bedding, toys, cot bumpers, sleep positioners, pods or nests

For more information on this important topic follow the links below:

Unicef's Caring for your Baby at Night is a great information website to give you more advice and information on safe sleeping. You can access this information by clicking here.

The Lullaby Trust have a very useful website to give your more information on safe sleeping. You can access the website by clicking here.

The children's flu vaccine is offered as a yearly nasal spray to young children to help protect them against flu.  Flu can be a very unpleasant illness for children, with potentially serious complications, including bronchitis and pneumonia. Vaccinating your child will not only protect them against flu but will also help protect more vulnerable friends and family by preventing the spread of flu.

The vaccination will be given by a quick and simple spray up the nose.

This is offered at your GP surgery.

You can find more information here Children's nasal flu vaccine (annual)

Encourage activity and play with your child. 180 minutes (3 hours a day) is the recommended guideline.  You are their role model so if you are an active family then that’s what they will see this as a normal thing to do and more likely to stay active as they grow.

Once your baby can walk you can encourage activities such as: 

• Jumping
• Skipping
• Messy play
• Hide and Seek
• Hunting for treasure
• Dancing
• Hopping
• Swimming

Avoid sugary food and drink before bedtime. They should be consumed less often and only at mealtimes. Try sugar free, diet or no added sugar drinks. Remember, plain water or lower fat milks are best. 

It’s free for kids under 18 to visit NHS dentists, so make sure you take them regularly.

Make sure your kids clean their teeth twice a day with a fluoride toothpaste. Help them brush once before bed and once at any other time that suits you and your family.

Your child should be encouraged to eat a variety of foods from the eatwell plate the same as the rest of the family. The four main food groups are:

• bread, other cereals and potatoes
• fruit and vegetables
• milk and dairy foods
• meat, fish and alternatives (such as eggs, pulses – peas, beans and lentils – nuts and soya).

There is no need to buy portion sized foods as this is more expensive and unnecessary. 

Sugary foods and drinks are not advised , but if they do have them occasionally, try to eat at meal times rather than as snacks. This will be better for their teeth and dental health is very important at this stage.

Avoid giving salt at the table and takeaway foods and also cooking with salt.

Children at this age should be drinking tap water as it’s the best option to quench their thirst and won’t damage their teeth. However, milk or diluted fruit juice (half and half) can be offered as an alternative. Stick to full fat milk until 2 years old and then semi-skimmed can be drunk.

Accidents happen, and often they happen in such a short space of time that before you can blink something has gone wrong.

When it comes to children it is important that you keep a close eye them.

Accidents can come in all different ways and types including:

·         Burns and scalds

·         Choking

·         Drowning

·         Falls

·         Strangulation

·         Suffocation

·         Accidental poisoning

The NHS website has some useful information and top tips to help you keep your child safe – you can access this information by clicking here.

If your child has an accident it is important to know what to do and when you need to seek medical advice, again the NHS website has a long list of information including where you can learn basic first aid on their website. Click here to read more.

Safety and pets

The Dog’s Trust has put together information about being dog smart around babies and children which you can access here.

Car seats

All children must use a car seat until they are 12 years old or 135 cm (whichever happens first).

The recommendations for the car seat position and type of seat change as the child grows and develops. The legal requirements can be found on the GOV.UK website. Specific safety advice relating to the car seat you have must be followed in order for it to work effectively.

Keeping walking safe

When walking near a road it is a good idea to:

• hold your child's hand - don't let them run ahead

• look out for and encourage your child to be aware of hidden entrances or driveways crossing the pavement
• put reins on a younger child if they're not strapped in a pushchair
• make sure your child walks on the side of the pavement away from the traffic
• Never let your child go near a road alone or even with an older child.
• Never let children play on driveways.

Children are usually not ready to cross roads on their own until they are at least eight years old - and many will not be ready even then.

Things to know about sun safety:

Keeping your child safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns and dehydration can occur and could cause some serious issues for your child.

If your child’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.

What should I do if i think there is a problem?

If you have any questions or would like some more information regarding sun safety and your baby you can ask your midwife / health visitor or GP for advice.

For more information please visit NHS England website. 

Keeping your child out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your child’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However, looking after your child's will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Dial 999 for an ambulance if your child:

• stops breathing or turns blue
• is struggling for breath
• is unconscious or seems unaware of what's going on
• will not wake up
• has a fit for the first time, even if they seem to recover.

Sleep is an amazing brain journey, we spend about a third of our life asleep. While each person is unique, sleep follows a fairly predictable pattern that changes through life.  We experience both deep and lighter sleep and even have brief awakenings during the night which are all part of ‘normal sleep’. 

The benefits of sleep include

• Promotes growth
   
• Strengthens our immunity
   
• Helps our bodies repair
   
• Consolidates our  memory and learning
   
• Maintains our physical and emotional health

Lack of sleep effects our general wellbeing

• Impacts on our emotional wellbeing and mood
   
• Physical health and coordination
   
• Our ability to learn new information and problem solve

This information has been taken from the NHS England website which you can access by clicking here.

If you are struggling to get your child to sleep or for them to stay asleep please do talk to your health visitor, midwife or GP.

Implementing Good Sleep Hygiene is an essential, easy way to provide an optimum environment and setting to strengthen the sleep-wake cycle and sleep associations, to help your child prepare for sleep, self-soothe to fall asleep and maintain sleep.

Good Sleep Hygiene can be divided into 4 main areas:

During the Daytime:

• Spend at least 30 minutes a day outside
• Have regular exercise such as playing in the park, cycling and/or attending an organised activity such as football or trampolining
• Ensure exercise happens early on in the day or directly after school. Avoid cardio-vascular exercise at least 4 hours before bed.
• Naps usually fade out at aged 3 years. Avoid naps after 2pm as this may affect your child’s ability to fall asleep at night.

Before Bedtime:

• No more than an hour before bed, begin the bedtime routine. Close the curtains and dim the light. The body takes ‘time givers’ from the environment to set the body clock; light is an important ‘time giver’. As the light fades, the secretion of melatonin is triggered. This is the body’s ‘sleepy hormone’. Melatonin does not maintain sleep, neither is it a sedative, it just gives the body a gentle signal that it is nearing the time for sleep.
• During the hour before bed, turn off the TV, introduce calming activities such as reading a story, puzzles, colouring or listening to soothing music. Music that is only played at bed time, helps to reinforce the association that it is nearing the time to go to sleep.
• Make sure your child is not hungry before bed. Offer a light supper such as warm milk and wholemeal toast or a yogurt. Avoid foods or drinks containing caffeine such as chocolate, coffee, tea and cola, particularly in the late afternoon and evening.
• Do not return to the lounge (or daytime room) after the evening bath. This provides an environmental cue to your child that it is ‘time for sleep’. 
• It is important to maintain a consistent routine every night. This helps to strengthen the association with sleep and strengthen the body clock.

The Bedroom

• There should be no electronic equipment in the bedroom.
• Prepare the bedroom for ‘sleep’.  Ensure the room is quiet and dark and free of clutter.
• Ensure the bedroom temperature is comfortable. Between 16-18 degrees is an ideal temperature.
• All toys should be put away or covered
• A comfortable bed is important
• Keep lighting low, avoid main lights
• Environmental noise should be kept to a minimum
• Remove any nocturnal pets that may interrupt  sleep

Bedtime and wake-up time

• Set a bedtime to be maintained every night that is age appropriate to your child
• Maintain a consistent sleep time and wake time 7 days a week. This strengthens the body clock

Settling your child

• Once the routine is complete, avoid extending the bedtime routine, for example, one more story or one more cuddle. Say a magic phrase, such as ‘time for sleep’.
• Turn out the light- the door may be left ajar if needed.
• Leave your child to settle alone.

The Robotic Parent Return Strategy

On waking during the night, some children will ‘alert’ their parent that they are awake by crying loudly or calling out. The Robotic parent return strategy is an effective strategy to avoid interaction with the child and encourages the child to learn to self-soothe.

• Do not carry or cuddle the child, gently lead the child back to bed
• Avoid eye contact
• The only communication, if needed, Is to repeat the ‘magic phrase’ such as ‘time for sleep’
• Reward your child in the morning for a better night’s sleep with lots of praise

Main Principles to promote quality sleep for children

• Clear and consistent routines
• Maintain Good Sleep Hygiene
• Good communication: For younger children, using objects of reference, such as a sponge to indicate it is time for a bath or using a photo or visual schedule of the order of the routine may be helpful. Older children could use a written schedule or a checklist that can be used independently.
• Ensure consistent responses to behaviour. Your child will ‘push back’ on the new routine initially and you may feel that things get worse before they get better.
• Reward your child with positive re-enforcement and lots of praise for ‘a better night’

THE BODY CLOCK

The body clock signals the body when it is time to sleep and when it is time to wake.  Most animals have a biological clock that governs its circadian (circ: about dian: day) rhythm.  The circadian rhythm controls many of our daily functions such as temperature, hormone secretion, blood pressure, including sleep and wakefulness.

In order to keep our circadian rhythm regulated our bodies react to signals or ‘time givers’. It takes signals or ‘time givers’ from:

• Light
• Temperature
• Food
• Social activities

Disruption to the body clock, can be caused by a difference between weekday and weekend settling and waking times - the jet lag effect is created when a change occurs in an individual’s settling and waking times. This can often occur at the weekend if an individual goes to bed much later on a Friday and Saturday night and rises much later on a Saturday and Sunday. The result can be equivalent to travelling across a different time zone and forcing your body to wake and sleep at a different time than you are used to. This change occurs again come Monday morning when the individual’s waking and settling times are brought forward.  

A shift in a child’s body clock can make them feel groggy and tired during the day.  Mental and physical performance will be reduced.

A shift in a child’s body clock impacts on sleep:

• Difficulty falling asleep - by trying to sleep when the body clock is not expecting to, and it is still set on ‘wake’. This can be especially pronounced on Sunday night and continue for a few days until your child’s body clock resets itself.
• Reduced sleep time - changes in your child’s body clock can disrupt sleep and lead to reduced sleep. If it takes you longer to fall asleep, but you have to wake at a set time (which can be much earlier during weekdays), it will reduce your sleep time leading to sleep deprivation and the associated health problems. 
• Difficulty waking in the morning - if your child’s body clock is set to ‘sleep’ and you are forcing it to wake up in order to get ready for school / nursery, they may feel groggy, have a headache, feel easily upset or angry, and nauseous. Reduced and fragmented sleep which is also a result of the jet lag effect will also make waking difficult.

These effects may last for a few days before your body clock resets itself. If an individual changes their sleeping and waking times every weekend, it means that they may experience prolonged sleep disruption and sleep deprivation due to constant jet lag effect. This may result in long-term mental and physical health problems.

Useful websites:

www.sleepscotland.org

ww.mind.org.uk

www.nhs.uk-change4life

Book references:

DrYemula.C.Roberts.A.(2014) Sleep Problems in Children and Young People: A Simple Teaching Aid. Health Insights 4U Ltd.

Prof.Stores.G.(2009) Sleep problems in children and adolescents: the facts. Oxford University Press.

Sound Sleep. Sleep Scotland (2010) Jewel&Esk College. Edinburgh.

The children's flu vaccine is offered as a yearly nasal spray to young children to help protect them against flu.  Flu can be a very unpleasant illness for children, with potentially serious complications, including bronchitis and pneumonia. Vaccinating your child will not only protect them against flu but will also help protect more vulnerable friends and family by preventing the spread of flu.

The vaccination will be given by a quick and simple spray up the nose.

This is offered at your GP surgery.

You can find more information here Children's nasal flu vaccine (annual)

Children should be getting at least 60 minutes of activity per day. It doesn’t have to be done in one go, you can break it down over the day.

Being active has so many social, emotional and physical health benefits. It’s great to be active as a family and there are lots of things you can do together locally and we have some wonderful country parks, swimming pools and cycle routes to try.

Avoid sugary food and drink before bedtime. They should be consumed less often and only at mealtimes. Try sugar free, diet or no added sugar drinks. Remember, plain water or lower fat milks are best.
 

It’s free for kids under 18 to visit NHS dentists, so make sure you take them regularly.
 

Make sure your kids clean their teeth twice a day with a fluoride toothpaste. Help them brush once before bed and once at any other time that suits you and your family.

5-11 year olds should be encouraged to eat a variety of foods from the eatwell plate the same as the rest of the family. The 4 main food groups are:

• bread, other cereals and potatoes
• fruit and vegetables
• milk and dairy foods
• meat, fish and alternatives (such as eggs, pulses – peas, beans and lentils – nuts and soya).

There is no need to buy portion sized foods as this is more expensive and unnecessary. Children above 5 years to adults should base their meals around starchy carbohydrates for energy, such as bread and pasta.

A lot of sugary foods and drinks are not advised for young children, but if they do have them occasionally, try to keep it to a minimum. This will be better for their teeth, promote a healthy weight and overall wellbeing.

Avoid giving salt at the table and takeaway foods too often and also cooking with salt.

Children at this age should be drinking tap water as it’s the best option to quench their thirst and won’t damage their teeth. However, milk or diluted fruit juice (half and half) can be offered as an alternative. 

Building a positive relationship with your child is the best way to help them develop positive emotional wellbeing. Sometimes it is difficult to understand why your child may display certain behaviours such as anger or being destructive.

It is worth taking time to take a few moments to think about what happened before the situation, during and after.  This can help identify what is triggering the behaviour, and provide ideas on what to do differently to reduce the chance of the behaviour occurring.  It can also be useful to consider what you were feleing and thinking at the time but also what your child was feeling and thinking.

Reward charts can work well with children for the age group of five to seven – ensure children receive “reward points” for small, realistic achievements and that the rewards at the end of the week / set time are something that provides positive re-enforcement. I.e. choosing an extra bed time story, choosing their favourite meal or a game to play. When using reward charts, rewards should not be removed once they have been earned.

Other elements to consider:

• Think about online activity and behaviours that children maybe witnessing through games and videos and how they may copy these (link into safety tab)
• Have clear rules about important matters (but keep to a minimum) be a positive role model by following these yourself
• Give more attention to your child when they are behaving sensibly rather than when they are behaving badly
• Look for the good things to praise, not criticise
• NEVER let them get what they want by misbehaving

Reacting to challenging behaviours 

So what can you do to help make sure you react calmly in situations where your child may be presenting with challenging behaviours?

A useful tool suggested by NSPCC is to Take 5. This process encourages you as a parent to stop, breathe and react calmly even in the situation of your child screaming in the middle of a supermarket, for example.

Watch the video here from other parents, their experiences and the suggestions they have to dealing with challenging behaviours calmly.  

Accidents happen, and often they happen in such a short space of time that before you can blink something has gone wrong.

When it comes to children it is important that you keep a close eye them.

Accidents can come in all different ways and types including:

·         Burns and scalds

·         Choking

·         Drowning

·         Falls

·         Strangulation

·         Suffocation

·         Accidental poisoning

The NHS website has some useful information and top tips to help you keep your child safe – you can access this information by clicking here.

If your child has an accident it is important to know what to do and when you need to seek medical advice, again the NHS website has a long list of information including where you can learn basic first aid on their website. Click here to read more.

Safety and pets

The Dog’s Trust has put together information about being dog smart around babies and children which you can access here.

Car seats

All children must use a car seat until they are 12 years old or 135 cm (whichever happens first).

The recommendations for the car seat position and type of seat change as the child grows and develops. The legal requirements can be found on the GOV.UK website. Specific safety advice relating to the car seat you have must be followed in order for it to work effectively.

Keeping walking safe

When walking near a road it is a good idea to:

• hold your child's hand - don't let them run ahead

• look out for and encourage your child to be aware of hidden entrances or driveways crossing the pavement
• put reins on a younger child if they're not strapped in a pushchair
• make sure your child walks on the side of the pavement away from the traffic
• Never let your child go near a road alone or even with an older child.
• Never let children play on driveways.

Children are usually not ready to cross roads on their own until they are at least eight years old - and many will not be ready even then.

Things to know about sun safety:

Keeping your child safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns and dehydration can occur and could cause some serious issues for your child.

If your child’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.

What should I do if i think there is a problem?

If you have any questions or would like some more information regarding sun safety and your baby you can ask your midwife / health visitor or GP for advice.

For more information please visit NHS England website. 

Keeping your child out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your child’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However, looking after your child's will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Dial 999 for an ambulance if your child:

• stops breathing or turns blue
• is struggling for breath
• is unconscious or seems unaware of what's going on
• will not wake up
• has a fit for the first time, even if they seem to recover.

Sleep is an amazing brain journey, we spend about a third of our life asleep. While each person is unique, sleep follows a fairly predictable pattern that changes through life.  We experience both deep and lighter sleep and even have brief awakenings during the night which are all part of ‘normal sleep’. 

The benefits of sleep include

• Promotes growth
   
• Strengthens our immunity
   
• Helps our bodies repair
   
• Consolidates our  memory and learning
   
• Maintains our physical and emotional health

Lack of sleep effects our general wellbeing

• Impacts on our emotional wellbeing and mood
   
• Physical health and coordination
   
• Our ability to learn new information and problem solve

This information has been taken from the NHS England website which you can access by clicking here.

If you are struggling to get your child to sleep or for them to stay asleep please do talk to your health visitor, midwife or GP.

Implementing Good Sleep Hygiene is an essential, easy way to provide an optimum environment and setting to strengthen the sleep-wake cycle and sleep associations, to help your child prepare for sleep, self-soothe to fall asleep and maintain sleep.

Good Sleep Hygiene can be divided into 4 main areas:

During the Daytime:

• Spend at least 30 minutes a day outside
• Have regular exercise such as playing in the park, cycling and/or attending an organised activity such as football or trampolining
• Ensure exercise happens early on in the day or directly after school. Avoid cardio-vascular exercise at least 4 hours before bed.
• Naps usually fade out at aged 3 years. Avoid naps after 2pm as this may affect your child’s ability to fall asleep at night.

Before Bedtime:

• No more than an hour before bed, begin the bedtime routine. Close the curtains and dim the light. The body takes ‘time givers’ from the environment to set the body clock; light is an important ‘time giver’. As the light fades, the secretion of melatonin is triggered. This is the body’s ‘sleepy hormone’. Melatonin does not maintain sleep, neither is it a sedative, it just gives the body a gentle signal that it is nearing the time for sleep.
• During the hour before bed, turn off the TV, introduce calming activities such as reading a story, puzzles, colouring or listening to soothing music. Music that is only played at bed time, helps to reinforce the association that it is nearing the time to go to sleep.
• Make sure your child is not hungry before bed. Offer a light supper such as warm milk and wholemeal toast or a yogurt. Avoid foods or drinks containing caffeine such as chocolate, coffee, tea and cola, particularly in the late afternoon and evening.
• Do not return to the lounge (or daytime room) after the evening bath. This provides an environmental cue to your child that it is ‘time for sleep’. 
• It is important to maintain a consistent routine every night. This helps to strengthen the association with sleep and strengthen the body clock.

The Bedroom

• There should be no electronic equipment in the bedroom.
• Prepare the bedroom for ‘sleep’.  Ensure the room is quiet and dark and free of clutter.
• Ensure the bedroom temperature is comfortable. Between 16-18 degrees is an ideal temperature.
• All toys should be put away or covered
• A comfortable bed is important
• Keep lighting low, avoid main lights
• Environmental noise should be kept to a minimum
• Remove any nocturnal pets that may interrupt  sleep

Bedtime and wake-up time

• Set a bedtime to be maintained every night that is age appropriate to your child
• Maintain a consistent sleep time and wake time 7 days a week. This strengthens the body clock

Settling your child

• Once the routine is complete, avoid extending the bedtime routine, for example, one more story or one more cuddle. Say a magic phrase, such as ‘time for sleep’.
• Turn out the light- the door may be left ajar if needed.
• Leave your child to settle alone.

The Robotic Parent Return Strategy

On waking during the night, some children will ‘alert’ their parent that they are awake by crying loudly or calling out. The Robotic parent return strategy is an effective strategy to avoid interaction with the child and encourages the child to learn to self-soothe.

• Do not carry or cuddle the child, gently lead the child back to bed
• Avoid eye contact
• The only communication, if needed, Is to repeat the ‘magic phrase’ such as ‘time for sleep’
• Reward your child in the morning for a better night’s sleep with lots of praise

Main Principles to promote quality sleep for children

• Clear and consistent routines
• Maintain Good Sleep Hygiene
• Good communication: For younger children, using objects of reference, such as a sponge to indicate it is time for a bath or using a photo or visual schedule of the order of the routine may be helpful. Older children could use a written schedule or a checklist that can be used independently.
• Ensure consistent responses to behaviour. Your child will ‘push back’ on the new routine initially and you may feel that things get worse before they get better.
• Reward your child with positive re-enforcement and lots of praise for ‘a better night’

THE BODY CLOCK

The body clock signals the body when it is time to sleep and when it is time to wake.  Most animals have a biological clock that governs its circadian (circ: about dian: day) rhythm.  The circadian rhythm controls many of our daily functions such as temperature, hormone secretion, blood pressure, including sleep and wakefulness.

In order to keep our circadian rhythm regulated our bodies react to signals or ‘time givers’. It takes signals or ‘time givers’ from:

• Light
• Temperature
• Food
• Social activities

Disruption to the body clock, can be caused by a difference between weekday and weekend settling and waking times - the jet lag effect is created when a change occurs in an individual’s settling and waking times. This can often occur at the weekend if an individual goes to bed much later on a Friday and Saturday night and rises much later on a Saturday and Sunday. The result can be equivalent to travelling across a different time zone and forcing your body to wake and sleep at a different time than you are used to. This change occurs again come Monday morning when the individual’s waking and settling times are brought forward.  

A shift in a child’s body clock can make them feel groggy and tired during the day.  Mental and physical performance will be reduced.

A shift in a child’s body clock impacts on sleep:

• Difficulty falling asleep - by trying to sleep when the body clock is not expecting to, and it is still set on ‘wake’. This can be especially pronounced on Sunday night and continue for a few days until your child’s body clock resets itself.
• Reduced sleep time - changes in your child’s body clock can disrupt sleep and lead to reduced sleep. If it takes you longer to fall asleep, but you have to wake at a set time (which can be much earlier during weekdays), it will reduce your sleep time leading to sleep deprivation and the associated health problems. 
• Difficulty waking in the morning - if your child’s body clock is set to ‘sleep’ and you are forcing it to wake up in order to get ready for school / nursery, they may feel groggy, have a headache, feel easily upset or angry, and nauseous. Reduced and fragmented sleep which is also a result of the jet lag effect will also make waking difficult.

These effects may last for a few days before your body clock resets itself. If an individual changes their sleeping and waking times every weekend, it means that they may experience prolonged sleep disruption and sleep deprivation due to constant jet lag effect. This may result in long-term mental and physical health problems.

Useful websites:

www.sleepscotland.org

ww.mind.org.uk

www.nhs.uk-change4life

Book references:

DrYemula.C.Roberts.A.(2014) Sleep Problems in Children and Young People: A Simple Teaching Aid. Health Insights 4U Ltd.

Prof.Stores.G.(2009) Sleep problems in children and adolescents: the facts. Oxford University Press.

Sound Sleep. Sleep Scotland (2010) Jewel&Esk College. Edinburgh.

The children's flu vaccine is offered as a yearly nasal spray to young children to help protect them against flu.  Flu can be a very unpleasant illness for children, with potentially serious complications, including bronchitis and pneumonia. Vaccinating your child will not only protect them against flu but will also help protect more vulnerable friends and family by preventing the spread of flu.

The vaccination will be given by a quick and simple spray up the nose.

This is offered at your GP surgery.

You can find more information here Children's nasal flu vaccine (annual)

Children should be getting at least 60 minutes of activity per day. It doesn’t have to be done in one go, you can break it down over the day.

Being active has so many social, emotional and physical health benefits. It’s great to be active as a family and there are lots of things you can do together locally and we have some wonderful country parks, swimming pools and cycle routes to try.

Avoid sugary food and drink before bedtime. They should be consumed less often and only at mealtimes. Try sugar free, diet or no added sugar drinks. Remember, plain water or lower fat milks are best.

It’s free for kids under 18 to visit NHS dentists, so make sure you take them regularly.

Make sure your kids clean their teeth twice a day with a fluoride toothpaste. Help them brush once before bed and once at any other time that suits you and your family.

5-11 year olds should be encouraged to eat a variety of foods from the eatwell plate the same as the rest of the family. The 4 main food groups are:

• bread, other cereals and potatoes
• fruit and vegetables
• milk and dairy foods
• meat, fish and alternatives (such as eggs, pulses – peas, beans and lentils – nuts and soya).

There is no need to buy portion sized foods as this is more expensive and unnecessary. Children above 5 years to adults should base their meals around starchy carbohydrates for energy, such as bread and pasta.

A lot of sugary foods and drinks are not advised for young children, but if they do have them occasionally, try to keep it to a minimum. This will be better for their teeth, promote a healthy weight and overall wellbeing.

Avoid giving salt at the table and takeaway foods too often and also cooking with salt.

Children at this age should be drinking tap water as it’s the best option to quench their thirst and won’t damage their teeth. However, milk or diluted fruit juice (half and half) can be offered as an alternative. 

Accidents happen, and often they happen in such a short space of time that before you can blink something has gone wrong.

When it comes to children it is important that you keep a close eye them.

Accidents can come in all different ways and types including:

·         Burns and scalds

·         Choking

·         Drowning

·         Falls

·         Strangulation

·         Suffocation

·         Accidental poisoning

The NHS website has some useful information and top tips to help you keep your child safe – you can access this information by clicking here.

If your child has an accident it is important to know what to do and when you need to seek medical advice, again the NHS website has a long list of information including where you can learn basic first aid on their website. Click here to read more.

Safety and pets

The Dog’s Trust has put together information about being dog smart around babies and children which you can access here.

Car seats

All children must use a car seat until they are 12 years old or 135 cm (whichever happens first).

The recommendations for the car seat position and type of seat change as the child grows and develops. The legal requirements can be found on the GOV.UK website. Specific safety advice relating to the car seat you have must be followed in order for it to work effectively.

Keeping walking safe

When walking near a road it is a good idea to:

• hold your child's hand - don't let them run ahead

• look out for and encourage your child to be aware of hidden entrances or driveways crossing the pavement
• put reins on a younger child if they're not strapped in a pushchair
• make sure your child walks on the side of the pavement away from the traffic
• Never let your child go near a road alone or even with an older child.
• Never let children play on driveways.

Children are usually not ready to cross roads on their own until they are at least eight years old - and many will not be ready even then.

Things to know about sun safety:

Keeping your child safe whilst they are in the sun is important to protecting their skin. Without sun safety and sun protection, sun burns and dehydration can occur and could cause some serious issues for your child.

If your child’s skin is going to be exposed to sunlight use a sunscreen with a minimum 50 SPF rating to protect them.

What should I do if i think there is a problem?

If you have any questions or would like some more information regarding sun safety and your baby you can ask your midwife / health visitor or GP for advice.

For more information please visit NHS England website. 

Keeping your child out of strong sunlight is very important to protect their skin from the harmful UVA and UVB rays.

Protecting your child’s skin, as well as your own skin, can be easily overlooked especially when the excitement of heading outside is builds. However, looking after your child's will help to keep them safe and lower the risk of sun burn and other sun related conditions.

Dial 999 for an ambulance if your child:

• stops breathing or turns blue
• is struggling for breath
• is unconscious or seems unaware of what's going on
• will not wake up
• has a fit for the first time, even if they seem to recover.

Sleep is an amazing brain journey, we spend about a third of our life asleep. While each person is unique, sleep follows a fairly predictable pattern that changes through life.  We experience both deep and lighter sleep and even have brief awakenings during the night which are all part of ‘normal sleep’. 

The benefits of sleep include

• Promotes growth
   
• Strengthens our immunity
   
• Helps our bodies repair
   
• Consolidates our  memory and learning
   
• Maintains our physical and emotional health

Lack of sleep effects our general wellbeing

• Impacts on our emotional wellbeing and mood
   
• Physical health and coordination
   
• Our ability to learn new information and problem solve

This information has been taken from the NHS England website which you can access by clicking here.

If you are struggling to get your child to sleep or for them to stay asleep please do talk to your health visitor, midwife or GP.

Implementing Good Sleep Hygiene is an essential, easy way to provide an optimum environment and setting to strengthen the sleep-wake cycle and sleep associations, to help your child prepare for sleep, self-soothe to fall asleep and maintain sleep.

Good Sleep Hygiene can be divided into 4 main areas:

During the Daytime:

• Spend at least 30 minutes a day outside
• Have regular exercise such as playing in the park, cycling and/or attending an organised activity such as football or trampolining
• Ensure exercise happens early on in the day or directly after school. Avoid cardio-vascular exercise at least 4 hours before bed.
• Naps usually fade out at aged 3 years. Avoid naps after 2pm as this may affect your child’s ability to fall asleep at night.

Before Bedtime:

• No more than an hour before bed, begin the bedtime routine. Close the curtains and dim the light. The body takes ‘time givers’ from the environment to set the body clock; light is an important ‘time giver’. As the light fades, the secretion of melatonin is triggered. This is the body’s ‘sleepy hormone’. Melatonin does not maintain sleep, neither is it a sedative, it just gives the body a gentle signal that it is nearing the time for sleep.
• During the hour before bed, turn off the TV, introduce calming activities such as reading a story, puzzles, colouring or listening to soothing music. Music that is only played at bed time, helps to reinforce the association that it is nearing the time to go to sleep.
• Make sure your child is not hungry before bed. Offer a light supper such as warm milk and wholemeal toast or a yogurt. Avoid foods or drinks containing caffeine such as chocolate, coffee, tea and cola, particularly in the late afternoon and evening.
• Do not return to the lounge (or daytime room) after the evening bath. This provides an environmental cue to your child that it is ‘time for sleep’. 
• It is important to maintain a consistent routine every night. This helps to strengthen the association with sleep and strengthen the body clock.

The Bedroom

• There should be no electronic equipment in the bedroom.
• Prepare the bedroom for ‘sleep’.  Ensure the room is quiet and dark and free of clutter.
• Ensure the bedroom temperature is comfortable. Between 16-18 degrees is an ideal temperature.
• All toys should be put away or covered
• A comfortable bed is important
• Keep lighting low, avoid main lights
• Environmental noise should be kept to a minimum
• Remove any nocturnal pets that may interrupt  sleep

Bedtime and wake-up time

• Set a bedtime to be maintained every night that is age appropriate to your child
• Maintain a consistent sleep time and wake time 7 days a week. This strengthens the body clock

Settling your child

• Once the routine is complete, avoid extending the bedtime routine, for example, one more story or one more cuddle. Say a magic phrase, such as ‘time for sleep’.
• Turn out the light- the door may be left ajar if needed.
• Leave your child to settle alone.

The Robotic Parent Return Strategy

On waking during the night, some children will ‘alert’ their parent that they are awake by crying loudly or calling out. The Robotic parent return strategy is an effective strategy to avoid interaction with the child and encourages the child to learn to self-soothe.

• Do not carry or cuddle the child, gently lead the child back to bed
• Avoid eye contact
• The only communication, if needed, Is to repeat the ‘magic phrase’ such as ‘time for sleep’
• Reward your child in the morning for a better night’s sleep with lots of praise

Main Principles to promote quality sleep for children

• Clear and consistent routines
• Maintain Good Sleep Hygiene
• Good communication: For younger children, using objects of reference, such as a sponge to indicate it is time for a bath or using a photo or visual schedule of the order of the routine may be helpful. Older children could use a written schedule or a checklist that can be used independently.
• Ensure consistent responses to behaviour. Your child will ‘push back’ on the new routine initially and you may feel that things get worse before they get better.
• Reward your child with positive re-enforcement and lots of praise for ‘a better night’

THE BODY CLOCK

The body clock signals the body when it is time to sleep and when it is time to wake.  Most animals have a biological clock that governs its circadian (circ: about dian: day) rhythm.  The circadian rhythm controls many of our daily functions such as temperature, hormone secretion, blood pressure, including sleep and wakefulness.

In order to keep our circadian rhythm regulated our bodies react to signals or ‘time givers’. It takes signals or ‘time givers’ from:

• Light
• Temperature
• Food
• Social activities

Disruption to the body clock, can be caused by a difference between weekday and weekend settling and waking times - the jet lag effect is created when a change occurs in an individual’s settling and waking times. This can often occur at the weekend if an individual goes to bed much later on a Friday and Saturday night and rises much later on a Saturday and Sunday. The result can be equivalent to travelling across a different time zone and forcing your body to wake and sleep at a different time than you are used to. This change occurs again come Monday morning when the individual’s waking and settling times are brought forward.  

A shift in a child’s body clock can make them feel groggy and tired during the day.  Mental and physical performance will be reduced.

A shift in a child’s body clock impacts on sleep:

• Difficulty falling asleep - by trying to sleep when the body clock is not expecting to, and it is still set on ‘wake’. This can be especially pronounced on Sunday night and continue for a few days until your child’s body clock resets itself.
• Reduced sleep time - changes in your child’s body clock can disrupt sleep and lead to reduced sleep. If it takes you longer to fall asleep, but you have to wake at a set time (which can be much earlier during weekdays), it will reduce your sleep time leading to sleep deprivation and the associated health problems. 
• Difficulty waking in the morning - if your child’s body clock is set to ‘sleep’ and you are forcing it to wake up in order to get ready for school / nursery, they may feel groggy, have a headache, feel easily upset or angry, and nauseous. Reduced and fragmented sleep which is also a result of the jet lag effect will also make waking difficult.

These effects may last for a few days before your body clock resets itself. If an individual changes their sleeping and waking times every weekend, it means that they may experience prolonged sleep disruption and sleep deprivation due to constant jet lag effect. This may result in long-term mental and physical health problems.

Useful websites:

www.sleepscotland.org

ww.mind.org.uk

www.nhs.uk-change4life

Book references:

DrYemula.C.Roberts.A.(2014) Sleep Problems in Children and Young People: A Simple Teaching Aid. Health Insights 4U Ltd.

Prof.Stores.G.(2009) Sleep problems in children and adolescents: the facts. Oxford University Press.

Sound Sleep. Sleep Scotland (2010) Jewel&Esk College. Edinburgh.

The children's flu vaccine is offered as a yearly nasal spray to young children to help protect them against flu.  Flu can be a very unpleasant illness for children, with potentially serious complications, including bronchitis and pneumonia. Vaccinating your child will not only protect them against flu but will also help protect more vulnerable friends and family by preventing the spread of flu.

The vaccination will be given by a quick and simple spray up the nose.

This is offered at your GP surgery.

You can find more information here Children's nasal flu vaccine (annual)

Children should be getting at least 60 minutes of activity per day. It doesn’t have to be done in one go, you can break it down over the day.

Being active has so many social, emotional and physical health benefits. It’s great to be active as a family and there are lots of things you can do together locally and we have some wonderful country parks, swimming pools and cycle routes to try.

Avoid sugary food and drink before bedtime. They should be consumed less often and only at mealtimes. Try sugar free, diet or no added sugar drinks. Remember, plain water or lower fat milks are best.

It’s free for kids under 18 to visit NHS dentists, so make sure you take them regularly.

Make sure your kids clean their teeth twice a day with a fluoride toothpaste. Help them brush once before bed and once at any other time that suits you and your family.

Children should be encouraged to eat a variety of foods from the eatwell plate the same as the rest of the family. The 4 main food groups are:

• bread, other cereals and potatoes
• fruit and vegetables
• milk and dairy foods
• meat, fish and alternatives (such as eggs, pulses – peas, beans and lentils – nuts and soya).

There is no need to buy portion sized foods as this is more expensive and unnecessary. Children above 5 years to adults should base their meals around starchy carbohydrates for energy, such as bread and pasta.

A lot of sugary foods and drinks are not advised for young children, but if they do have them occasionally, try to keep it to a minimum. This will be better for their teeth, promote a healthy weight and overall wellbeing.

Avoid giving salt at the table and takeaway foods too often and also cooking with salt.

So what can you do to help make sure you react calmly in situations where your child may be presenting with challenging behaviours?

A useful tool suggested by NSPCC is to Take 5. This process encourages you as a parent to stop, breathe and react calmly even in the situation of your child screaming in the middle of a supermarket, for example.

Watch the video here from other parents, their experiences and the suggestions they have to dealing with challenging behaviours calmly.  

Accidents happen, and often they happen in such a short space of time that before you can blink something has gone wrong.

When it comes to children it is important that you keep a close eye them.

Accidents can come in all different ways and types including:

·         Burns and scalds

·         Choking

·         Drowning

·         Falls

·         Strangulation

·         Suffocation

·         Accidental poisoning

The NHS website has some useful information and top tips to help you keep your child safe – you can access this information by clicking here.

If your child has an accident it is important to know what to do and when you need to seek medical advice, again the NHS website has a long list of information including where you can learn basic first aid on their website. Click here to read more.

Safety and pets

The Dog’s Trust has put together information about being dog smart around babies and children which you can access here.

Car seats

All children must use a car seat until they are 12 years old or 135 cm (whichever happens first).

The recommendations for the car seat position and type of seat change as the child grows and develops. The legal requirements can be found on the GOV.UK website. Specific safety advice relating to the car seat you have must be followed in order for it to work effectively.

Keeping walking safe

When walking near a road it is a good idea to:

• look out for and encourage your child to be aware of hidden entrances or driveways crossing the pavement
• make sure your child walks on the side of the pavement away from the traffic
• Never let your child go near a road alone or even with an older child.
• Never let children play on driveways.

Dial 999 for an ambulance if your child:

• stops breathing or turns blue
• is struggling for breath
• is unconscious or seems unaware of what's going on
• will not wake up
• has a fit for the first time, even if they seem to recover.

Sleep is an amazing brain journey and is crucial for brain development during childhood and adolescence. There are number of functions for sleep that include, consolidation of  the memory and learning,  assisting  with  the development of the child’s vocabulary, pronunciation and ability to remember words and sounds. It promotes growth, strengthens immunity, helps with cell repair and healing and maintains physical and emotional health

Difficulties in achieving good quality sleep can have a significant effect on the child’s general wellbeing, on mood, physical coordination and ability to learn and retain new information.  Behaviour and social difficulties may result as the body struggles with lethargy, irritability and heightened emotional responses.

It is important to rule out any medical or emotional condition that may be affecting your child’s ability to sleep.

If you have any medical concerns regarding your child, it is important that you seek expert advice and support from your GP.

Sleep difficulties may be due to behaviours. This is often seen in young children

• Limit setting: This is when the child refuses to go to bed or continually gets out of bed. The child makes demands on the parent. Such demands include, ‘one more story’, ‘I’m hungry’, ‘I need a drink’, demonstrating attention seeking behaviours that exhaust parents and result in the whole family dreading bedtime!

• Sleep-onset association: This is when the child requires intervention from a parent. For a younger child, such as rocking, and /or feeding and for both younger and older children, for a parent to be present, often lying with the child until they are asleep. Upon waking at night, the child requires the same setting in order to get back to sleep.

• Combined: The child demonstrates limit setting and sleep onset association concerns

How you can help your child to sleep?

Implementing good sleep hygiene is an essential, easy way to provide an optimum environment and setting to strengthen the sleep-wake cycle and sleep associations, to help your child prepare for sleep, self-soothe to fall asleep and maintain sleep.

Good sleep hygiene can be divided into four main areas:

During the daytime:

• Spend at least 30 minutes a day outside
• Have regular exercise such as playing in the park, cycling and/or attending an organised activity such as football or trampolining
• Ensure exercise happens early on in the day or directly after school. Avoid cardio-vascular exercise at least 4 hours before bed.
• Naps usually fade out at aged 3 years. Avoid naps after 2pm as this may affect your child’s ability to fall asleep at night.

Before bedtime:

• No more than an hour before bed, begin the bedtime routine. Close the curtains and dim the light. The body takes ‘time givers’ from the environment to set the body clock; light is an important ‘time giver’. As the light fades, the secretion of melatonin is triggered. This is the body’s ‘sleepy hormone’. Melatonin does not maintain sleep, neither is it a sedative, it just gives the body a gentle signal that it is nearing the time for sleep.
• During the hour before bed, turn off the TV, introduce calming activities such as reading a story, puzzles, colouring or listening to soothing music. Music that is only played at bed time, helps to reinforce the association that it is nearing the time to go to sleep.
• Make sure your child is not hungry before bed. Offer a light supper such as warm milk and wholemeal toast or a yogurt. Avoid foods or drinks containing caffeine such as chocolate, coffee, tea and cola, particularly in the late afternoon and evening.
• Do not return to the lounge (or daytime room) after the evening bath. This provides an environmental cue to your child that it is ‘time for sleep’. 
• It is important to maintain a consistent routine every night. This helps to strengthen the association with sleep and strengthen the body clock.

The Bedroom

• There should be no electronic equipment in the bedroom.
• Prepare the bedroom for ‘sleep’.  Ensure the room is quiet and dark and free of clutter.
• Ensure the bedroom temperature is comfortable. Between 16-18 degrees is an ideal temperature.
• All toys should be put away or covered
• A comfortable bed is important
• Keep lighting low, avoid main lights
• Environmental noise should be kept to a minimum
• Remove any nocturnal pets that may interrupt  sleep

Bedtime and wake-up time

• Set a bedtime to be maintained every night that is age appropriate to your child
• Maintain a consistent sleep time and wake time 7 days a week. This strengthens the body clock

As discussed when looking at younger children, maintaining a consistent routine and implementing Good Sleep Hygiene is essential to achieve an adequate sleep/wake cycle and quality sleep. The same principles apply to everyone, whatever their age.

However, there are some additional considerations for the teenager.

• Electronic equipment: Staying ‘connected’ is so important to teenagers. Indeed, using electronic equipment can benefit learning opportunities, social contact and keep up to date with issues around the world. However, it is important to put boundaries on their use. Particularly in the evening. Computer games can be stimulating and the light emitted from the screen can affect our ability to produce melatonin. All technology and electronic equipment should be turned off at least one hour before bed and removed from the bedroom overnight.
• Emotional Wellbeing: It is normal to ‘worry’, it can even act as a fuel to motivate us to achieve something. However, if our worries spiral out of control, this can significantly affect our ability to sleep. It is important to share any worries with an adult you trust, perhaps a parent, teacher or your school nurse. Talking about your worries early in the day and learning strategies to manage your worries and other wellbeing issues will help you to achieve good quality sleep.
• School pressures: Increasing work pressures and deadlines loom large at times. If you are finding things are becoming overwhelming, discuss this with a teacher or trusted adult. Learning to manage your workload is essential to avoid late night ‘study’ that affects your function the next day and increases your sleep debt.
• Caffeine: When feeling tired and lethargic, you may find yourself reaching for a coffee or other caffeine containing drink such as energy drinks or Cola to keep you awake. Caffeine can reduce the production of melatonin ( the sleep hormone) and is a stimulant. Avoid caffeine based foods such as those containing chocolate in the evening too.

The average sleep need for a teenager is 9 ¼ hours

‘I’m a teenager, it’s an important time for me, I’m preparing for exams, making new relationships, I’m developing my own values and beliefs and the ability to reason and problem solve. But I’m finding it hard to sleep. What is happening and what can I do?’

Adolescence is a time of lots of change, for the body (puberty) and the brain. During adolescence your brain goes through a time of significant development, particularly the pre-frontal cortex, that regulates your emotional responses and reasoning. The body clock changes too and can be set back by 2 hours. As a result, you feel more alert later, fall asleep later and then wake later. This is normal development but it can have a significant effect on daytime function and the ability to get up in time for school!

As seen in younger children, sleep deprivation effects learning, emotional wellbeing and physical health.

• Maintain a consistent routine
• Be aware that your body clock will naturally move about 2 hours, therefore implementing Good Sleep Hygiene is essential
• Talk with your friends about agreeing a time when everyone will ‘turn off’ social media and other electronic equipment
• Share any worries or concerns. This is taking control of your emotional wellbeing and is a positive strength
• Be mindful of the stimulant effect of caffeine on the body and try and avoid after lunchtime
• Don’t keep your knowledge on sleep to yourself … tell your friends, share the amazing effect quality sleep can have on your wellbeing, helping you to reach your potential physically, emotionally and socially.

References:

DrYemula.C.Roberts.A.(2014) Sleep Problems in Children and Young People: A Simple Teaching Aid. Health Insights 4U Ltd.

Prof.Stores.G.(2009) Sleep problems in children and adolescents: the facts. Oxford University Press.

Sound Sleep. Sleep Scotland (2010) Jewel&Esk College. Edinburgh.

www.sleepscotland.org

ww.mind.org.uk

www.nhs.uk-change4life

The school nursing team offer the following vaccinations in Secondary school:

HPV vaccinations in Year 8 (2 doses, 6 months apart)

HPV vaccine From September 2019, all 12 and 13-year-olds in school Year 8 will be offered on the NHS the human papillomavirus (HPV) vaccine. 

It helps protect against cancers caused by HPV, including: 

• Cervical cancer
• Some mouth and throat (head and neck) cancers
• Some cancers of the anal and genital areas

As well as protecting against 90% of genital warts.

In England, girls and boys aged 12 to 13 years will be routinely offered their HPV vaccinations when they're in school Year 8. It's important to have both doses to be protected.

When will the vaccinations take place?

Immunisation dates:

• HPV Vaccinations September :(1st dose) April-June (2nd dose)
• Flu vaccinations: October - December
• Teenage booster vaccinations:  Feb- March.

The school nursing team will visit your child’s school once to offer the vaccinations. A consent form (paper or e-consent) will be sent home approximately two to four weeks prior to the planned immunisation session. (For exact dates of Immunisation sessions please check with your child’s school calendar.) 

Men ACWY and DTP (Diphtheria, Tetanus, Polio) vaccinations in Year 9

Men ACWY vaccine  The Men ACWY vaccine is given by a single vaccine and protects against four different strains of meningococcal bacteria that cause meningitis and blood poisoning (septicaemia): A, C, W, and Y.

3-in-1 teenage booster (DTP) The teenage booster, also known as the three-in-one or the Td/IPV vaccine. It is a single vaccine given to boost protection against 3 separate diseases: tetanus, diphtheria and polio.

This Immunisations for Young People Guide outlines and explains these vaccinations and why they are needed.

Immunisation dates:

• HPV Vaccinations September :(1st dose) April-June (2nd dose)
• Flu vaccinations: October - December
• Teenage booster vaccinations:  Feb- March.

The Relate website has some useful information and tips on talking to your children around a full range of issues from relationships to drugs and alcohol and managing behaviours:

Whatever the type of relationship you are in it is important to make sure it is healthy and that you know how to access services to support your physical / sexual health.

www.fpa.org.uk/sites/default/files/is-this-love-non-printing.pdf

thelowdown.info/ Has lots of information about relationships and sexual health.

Your practice nurse / family doctor can advise you around contraception and further information is available via our sexual health team at: www.nhft.nhs.uk/sexual-health

It is also important to regularly check yourself for any “unusual” lumps or bumps – see the links below and if you are worried about anything contact your GP for advice.

Boys bodies Q&As https://bit.ly/2TLzgUI

Girls bodies https://bit.ly/2tmhtYu

Boys self examination and testicular cancer: http://mvmbr.co/1jlLNMc

Breast awareness: https://bit.ly/1I0PZs1 Remember most breast lumps are harmless and both men and women can be affected by breast cancer.