Providing nursing care and support for children and young people

The Community Children’s Nurses support children with nursing and health care needs and their families, at home and in the community.

We provide nursing care and support in children’s homes or other community settings, such as nurseries or schools.  We prevent or reduce hospital admissions for children and young people and provide families and carers with information, resources and support to promote independence, as far as possible.

 

 

  • I had my first baby six months ago but I am finding it very difficult to leave the house and feel very teary most of the time. It should be the happiest time of my life but I don’t know why I am feeling so sad?
  • My two-year-old boy does not speak at all. He cannot even say mama or dada and only makes baby noises. Is this normal?
  • I breastfed my two month old baby and often fall asleep with him in my bed afterwards during the night. Is it okay to share my bed with my baby?
  • Skills for getting ready for Toilet Time

Around 50% of new mothers can experience ‘baby blues’ for 5-10 days following the birth of their baby and experience irritability, changing moods and feeling tearful.

If symptoms of low mood persist, then it is possible it could be postnatal depression. Research suggests that depression affects 11.8% of women antenatally and 10-15% in the postnatal period .Whilst postnatal depression is most common in the first six months after birth, it can continue into the second year for 33% of women and the third year for 10% of women.

It is helpful to talk how you are feeling through with loved ones and supportive friends, family and your GP. Health Visitors are there to also offer support and advice at such times. Together we can look at how you are feeling and consider whether you may have postnatal depression by asking a few questions or asking you to complete a 10 point questionnaire called the EPDS.

 Dependent upon the outcome then there are a range of services on offer and are specific to whether your symptoms are mild, moderate or severe. We can explain signpost to ones that are most appropriate for you. 

HVs provide mothers with details of local support groups, such as postnatal support groups where you may visit as your symptoms improve and confidence to go out builds.

                            

By 2 years your toddler will usually use 50 or more single words, start to put two to three word sentences together, ask simple questions such as ‘Who’s that?’ and ‘What’s that?’, understand 200-300 words and simple questions and enjoy pretend play with their toys.

You will know your child’s development best and at two years of age we contact all families to offer a two year developmental assessment and send out a questionnaire which we request you complete as much as possible and bring to the appointment.

The Ages and Stages Questionnaire (ASQ) is a parent led assessment of age related development. The questionnaire helps parents and professionals work together to review 5 areas of child development including gross motor skills, fine motor skills, personal and social skills, problem solving and communication (including speech and language development).

If there are areas of development that are delayed then your Health Visitor can you refer you on. In this case a referral to a Speech and Language therapist may be indicated. There are things that you can do to promote speech and language too, such as:

Say and sing action rhymes and songs,

Share and read books together and

Repeat and expand on what your child already says, as this shows your child how words can be put together to make short sentences.

 

Health Visitors give advice around safer sleeping for your baby and this reflects that advice given by The Lullaby Trust (http://www.lullabytrust.org.uk/safer-sleep) which aims to reduce SIDS and ensure that your baby sleeps as safely as possible. This concerns all sleeps that your baby takes and not just night time.

In general the advice from The Lullaby Trust is as follows:

 

THINGS YOU CAN DO:

Always place your baby on their back to sleep

Keep your baby smoke free during pregnancy and after birth

Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months

Breastfeed your baby, if you can

Use a firm, flat, waterproof mattress in good condition


THINGS TO AVOID:


Never sleep on a sofa or in an armchair with your baby

Don’t sleep in the same bed as your baby if you smoke, drink or take drugs or are extremely tired, if your baby was born prematurely or was of low birth-weight

Avoid letting your baby get too hot

Don’t cover your baby’s face or head while sleeping or use loose bedding

 

Health Visitors can also give breastfeeding advice and support and together you may consider alternative strategies and approaches to feeding that alleviate the issue you have raised. We can discuss this at our Child Health Clinics and at our Breastfeeding Buddies groups.

      

   

  Everybody is getting ready for toilet time!

 Before starting toilet training these are some of the skills you can help your child to acquire, which will make it much easier for them to become toilet trained happily when you decide it’s a good time to start.  

  1. Most Important! Do all changing of nappies/pull ups in the bathroom or toilet, from now on. Some children find this a difficult change to make especially if changing has been done up to now in a room with a TV, in the bedroom or lounge, with people and toys around. The key is to be firm but calm, and don’t give in.

It needs to become part of their daily routine to visit the toilet area, whenever you are doing anything to do with poo or wee. This will make a big difference when you do come to put pants on your child as its one less battle to have, at what will be a big step for the family. Your child will then already be able to follow the instruction “Toilet Time” and understand what it means and what is expected of them, which will make it much easier for them to achieve staying dry.

  1. Make changing/checking pad, in the toilet part of your daily routine, and where possible sticking to roughly the same times each day. Here are some examples:
    • When they get up           
    • After snack, lunch and dinner
    • Before Bath time
  1. Always use the same words when asking them to come to the toilet area to change their pad. I would suggest “Toilet Time”, as then once they are wearing pants you can continue to use the same command. Encourage all people who spend time with the child to use the same words. Do not ask your child if they would like to come to the toilet, they need to understand that it is you telling them, it’s not a choice at this stage.

Following a command is a great skill for your child to learn, starting with family and friends, and then at nursery. Say the command in a confident, happy voice so that they know you think this is a good, positive activity to do. You can give the child a minute to think about what you have asked and then if necessary repeat the same command again, taking their hand to encourage them to come with you.

  1. Reassure the child about the activity they will be coming back to once Toilet time is finished using few words. E.g. “Toilet time then play with cars/ TV / go in the car / see grandma”, etc. This will offer a natural reward for following your command and completing the routine.  

 Positively reinforce this during the toilet visit. For example; “Well done coming to the toilet, then you can play with your cars, good girl.”

  1. Have a box with 2/3 really fun toys or books in the bathroom for your little one to look at whilst there. Keep those toys in the bathroom only to be used whilst in there, not taken out!
  2. Change standing up (unless soiled, always put the poo in the toilet from the nappy.). At this stage, you could swap to pull ups if you find it difficult to do a nappy standing up. They can use the bath or sink to hold onto for support. Praise, encourage and support them during each completed part of the toilet routine, e.g. “what a big girl, well done!” This is great to boost their self-esteem and make them feel good about growing up.
  3. Always follow the same routine when visiting the toilet.                                             The Toilet time routine could be:
  • Say “It’s Toilet Time”, go to the bathroom.
  • Stand and pull down clothes. Encourage children to do this for themselves, but at this stage you can help.
  • Take off old pad.
  • Sit on potty/toilet, with help if needed. I would not expect them to wee or poo at this stage, but if by chance they do, huge celebration!!! (if using a potty, tip the wee/poo into the toilet) Whilst they are sat on the potty/toilet they can blow some bubbles, this is fun and also encourages them to wee. You can even get an app on your phone to blow up a balloon!
  • Stand up and wipe with toilet paper and/or flushable wipes, and put into the toilet.
  • Put on new pad and pull up clothes.
  • Support them to flush the toilet. This will make sure they are not frightened of the flush as well as being fun and rewarding for them.
  • Use a step to climb up and wash hands, then dry them. Again a natural reward for following the routine.Well done for helping your child move to the next exciting stage!
  • It’s nice to give children a choice of potty or toilet. If your child would like to use the toilet make sure you have a sturdy step and a secure toilet seat ready for them to use. At this stage boys need to learn to wee sitting down, not standing, as they must feel happy to sit when it comes time to poo on the toilet. It is not necessary for them to stay on the potty/toilet for any specific length of time at this stage, just be really positive and praise them that they have sat, even for 10 seconds!  

Well done for helping your child move to the next exciting stage!